Comprehensive Consideration of Surgical Technique for Head and Neck Tumors

Shih-Jung CHENG

  Oral cancer is one of the major cancers in Taiwan especially for male, and it is the fourth leading cause for male cancer death in Taiwan. Generally, radical resection combined with chemo-radiation remains the main treatment strategy for advanced oral cancer, although the 5-year survival is not substantially improved and still less than 20%. However, the advanced oral cancer involving the floor-of mouth, base-of-tongue, nasal cavity and infratemporal region challenges surgeon’s techniques, but possibly provides us to ameliorate skills, and in turn to apply to manage difficult head and neck tumor. Herein, three surgical techniques were introduced, including pull-through technique, infra-temporal resection and mid-facial de-gloving surgery.

First, pull-through technique usually applies for resection of tongue or base-of-tongue cancer involving the floor-of-mouth without mandibular lip splitting. In contrast, the pull-through mandibular tumor was totally excised from the cervical approach not in oral cavity. Pull-through technique may decrease complication rate, spare blood loss, save surgical time, shorten hospital stay duration, and improve the postoperative esthetics, but the technique should be carefully applied to ensure the total eradication of the tumor.

Second, the comprehensive surgery of extensive oral cancers with infratemporal invasion challenges the surgeon’s judgment and technique. Infratemporal resection is staged surgical procedures as temporary ligation of ECA, and identification of  ICA, pterygoid plate, choana, E-tube and styloid process with zygomatic arch approach and downward-outward traction to sacrifice tumor. The technique may improve some inoperable tumor resected. However, perio- and post-operative massive bleeding, ECA/ICA injury with pseudo-aneurysm, hearing loss, blindness or ectropion may be carefully monitored. However, detailed physical examination and imaging study are of utmost importance.
  Third, mid-facial de-gloving surgery may apply for oral tumor invading into nasal septum or turbinate. The surgical procedure incises the demarcation from nasal approach, followed by intra-oral excision and removed the oro-nasal tumor via oral cavity. The technique is characteristic of preserving upper labial integrity without Weber- Fergusson incision, and furthermore improving post-operative cosmetics. 

Orthognathic Managements for Cleft Lip and Palate Patients

 Professor Yong-Deok KIM

金容德 教授

Pusan National University

 

  Cleft lip and palate(CLP) is the most frequent congenital facial abnormality. Cleft lip and palate patients might have unfavorable smile esthetics and low self-esteem, leading mainly to difficulties in social interactions. Moreover, patients with CLP present typical characteristics, such as deficiency in midface development, orthodontic Class III tendency, and significantly smaller ANB angle, presence of oronasal fistula in some cases, alterations in shape and number of lateral incisors and the presence of supernumerary teeth occasionally.

  Since the 1970s, CLP deformities have conventionally been corrected by orthognathic surgery, and since the late 1990s, distraction osteogenesis has been recognized as an acceptable alternative for treatment of maxillary hypoplasia in patients with CLP. But there are some indications for distraction osteogenesis such as skeletal immaturity, requiring advancement of more than 7mm of maxilla, severe fibrosis of lip and palate. So, orthognathic surgery is usually the final phase of treatment for patients with cleft lip and palate. The traditional surgical procedure for correcting associated maxillary retrusion is a Le Fort I osteotomy.

  In this presentation, I investigated various predisposing factors influencing postoperative stability after orthognathic surgery in cleft lip and palate patients. Preoperative and postoperative changes were compared using cephalometrics for orthognathic surgery system to determine stability of skeletal movement and quantity amount of relapse.   

  Distraction osteogenesis has been extensively used to correct severe midface hypoplasia. However few studies have reported midface distraction long term outcomes, especially before teenagers through cephalometric evaluation. The second purpose of the present study was to evaluate outcomes with midface distraction rigid external device (RED) in young (before 12 years old) patients with cleft lip and, in terms of quantity of bone lengthening, skeletal stability and facial growth. Seven patients were retrospectively evaluated in this study. Cephalometrics was carried out through three teleradiographies from each patient (T0 -before surgery; T1- immediate postop, right after distracter removal; T2- late postop, obtained with a minimal interval of 12 months after surgery; T3 – before final orthognathic surgery; T4 – after orthognathic surgery). Significant midface advancements were achieved with the procedures. The rate of horizontal relapse was minimal. But we noticed all of patients’ positive overjets were relapsed after some periods and they needed to have final orthognathic surgeries with bone graft or not. The periods which the patients had class I key were short than expected by clinicians and at this point the efficacy of this procedure was unclear for young cleft children. Cephalometric evaluation showed inadequate results in midface bone lengthening with rigid external distracter to children. Authors concluded that DO with RED system was not recommended to young patients (before teenager) but to young adults.

The Efficiency of Setback Le Fort I Osteotomy

 Professor Yong-Deok KIM

Pusan National University

 

Orthodontic preparation for orthognathic surgery plays an important role in determining the direction/amount of skeletal movement and dental rearrangement for the skeletal postoperative stability. During the preoperative orthodontic treatment the securing spaces and the dental rearrangement through the extraction of a certain teeth were performed for the facial profile, dentition and the compensation of the skeletal change of patient. Because the choice of extraction / non - extraction treatment affects the orthodontic purposes, as well as the option or procedure of the orthognathic surgery, sometimes it results the positive effect on predictable surgery and also puts on difficulties. For example, non-extraction orthodontic treatment would make the surgery difficult due to insufficient AP discrepancy compared to the skeletal disharmony of the patient or extraction one might make the up-righting of upper incisors which would limit the movement of maxilla or prohibit the improvement of facial esthetics through the proper surgery especially in Class III malocclusion patients. However, these limitations have been significantly eliminated by recent studies and attempts of the various 3-dimentional skeletal movements including rotational or setback movement of maxilla. Accordingly, the current trend is the high proportion of non-extraction treatment and 2-jaw surgery compared to extraction and 1-jaw. The purpose of the presentation is to introduce the maxillary posterior reposition affecting the choice of the extraction/non-extraction orthodontic treatment and to find out how it affects the orthognathic treatment plan which is made by orthodontists and surgeons. In particular, I would like to share our experiences for the exact setback Le Fort I osteotomy methodologically.

Paili Chen

Curriculum Vitae

Dr. Paili Chen

Doctor of Dental Surgery from School of Dentistry, Kaohsiung Medical College

Master of Science  from Graduate Institute of Dental Science, School of Dentistry , Kaohsiung Medical University

Certified Training in Oral and Maxillofacial Surgery at Kaohsiung Medical University Chung-Ho Memorial Hospital

Diplomat of Association of Oral and Maxillofacial Surgeons, Taiwan

Director of South Taiwan Association of Implant Dentistry

Private Practice limited in Oral Surgery and Oral Implantology in Chiayi City , Taiwan 

CHEN-HSI TSAI

Education:

2009~2015 D.D.S

School of Dentistry, Kaohsiung Medical University, Taiwan

Experience:

2013~2015:

＊Assistant in Department of Oral and Maxillofacial Anatomy, 

    Kaohsiung Medical University

＊Publication of Manual of Oral and Maxillofacial Anatomy Laboratory, Kaohsiung Medical     University 

Michael Yuanchien CHEN

  Curriculum Vitae

Dr.  Michael Yuanchien Chen  D.D.S.  M.S. 

Present Positions：

Chairman, (2010~)

    Department of Dentistry,

    Taichung China Medical University Hospital. Taiwan.

Chief, ( 2002 ~ )

Division of Oral and Maxillofacial Surgery,

Taichung China Medical University Hospital.

Taichung City, Taiwan.

    Assistant Professor, (2011 ~)

        School of Dentistry, College of Medicine, Taichung China Medical University, Taichung City, Taiwan.

    Assistant Professor, (2010 ~)

        School of Dentistry, College of Oral Medicine, Kaohsiung Medical University. Kaohsiung City, Taiwan.

    Board of Directors, (2009 ~ ) &

      Executive Director /Chairman of International Committee, (2011 ~)

Taiwan Association of Oral & Maxillofacial Surgeon

    Editorial board members, (2009 ~ 2015)

        Taiwan Journal of Oral & Maxillofacial Surgery

Editorial board members, (2009 ~ )

        Asian Journal of Oral & Maxillofacial Surgery

    Editorial Board Members, (2012~)

        Annals of Maxillofacial Surgery

Office Address：

        Taichung China Medical University & University Hospital

2, Yuh-Der Rd. Taichung City, TAIWAN

        ZIP Code: 40447

Phone No.：+886-4-22052121  Ext 2580~3

        Fax ：+886-4-22083403

        Email: mychen@mail.cmuh.org.tw

Education：

  1980~1986  D.D.S.

School of Dentistry, Kaohsiung Medical University, Taiwan.

1993  Implant Course, University of Alabama at Birmingham, USA

1998  Bone Grafting Course, University of Miami, USA

  2001  Orthognathic Surgery Course, National Seoul University, Korea.

  2000~2002  M.S.

Institute of Medical Science, China Medical University, Taiwan. 

Experiences：

        1986~1988  Military Surgeon

        1988~1990  Resident, Department of Oral & Maxillofacial Surgery, Kaohsiung Medical university Hospital, Kaohsiung City, Taiwan

        1990~1992  Chief Resident, Department of Oral & Maxillofacial Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

        1992~1997  Attending Surgeon, Department of Dentistry, Sha Lu Tung’s General Hospital, Taichung County, Taiwan

1994~1996  Attending surgeon, Department of Oral & Maxillofacial Surgery Chia-Yi Christian Hospital, Chiayi City, Taiwan

        1994~1997  Attending Surgeon, Department of Oral & Maxillofacial Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

        1997~2000  Chief, Department of Dentistry, Sha-Lu Tungs General Hospital Taichung County, Taiwan

1998~2003  Attending Surgeon, Department of Oral & Maxillofacial Surgery, China Medical University Hospital, Taichung City, Taiwan

2004 ~ 2011  Senior Lecturer,

School of Dentistry, Taichung China Medical University.

Taichung City, Taiwan.

Chairman, ( 2005 ~ 2009)

        Constitutional Committee, Taiwan Association of Oral & Maxillofacial Surgeon

      Vice Chairman, ( 2005 ~ 2009)

        Educational Committee, Taiwan Association of Oral & Maxillofacial Surgeon.

 Chairman, ( 2008, 2016)

        Organizing Committee, of the 20^th & 28 ^th Annual Conference on Oral & Maxillofacial Surgery at China Medical University, Taichung City, Taiwan.

Recent Invited Speech Abroad:

        Singapore National University, Sep. 2008

        Vietnam Association of Stomatology, Oct. 2010

        34^th APDC at Taipei, Jun. 2012

        57^th Annual Congress of Japanese Society of Oral &

Maxillofacial Surgery. Oct. 2012

        36 ^th APDC at Dubai,United Arab Emirates. Jun 2014

Awards：

        2000  The Best Thesis in the 12^th  Annual Conference on Oral & Maxillofacial Surgery, Kaohsiung city, Taiwan.

        2001  The Best Teaching Staff of the Department of Dentistry, University Hospital of China Medical University, Taichung city, Taiwan.

        2003  The Best Teaching Staff of the Department of Dentistry, University Hospital of China Medical University, Taichung city, Taiwan.

        2006  The Best Thesis in the 18^th  Annual Conference on Oral & Maxillofacial Surgery, Tainan city, Taiwan.

2007     Award of Outstanding Contributions on Clinical Teaching & Research, Taichung China Medical University, Taichung city, Taiwan

        2014  The Best Teaching Staff of the Department of Dentistry, University Hospital of China Medical University, Taichung city, Taiwan.

        2014  The Best Teaching and Innovative Teacher of Dentistry, China Medical University, Taichung city, Taiwan.

Membership：

      Diplomate, Taiwan Association of Oral & Maxillofacial Surgery

      Diplomate, Taiwan Association of Oral & Maxillofacial Radiology

      Diplomate, ROC（Taiwan） Academy of Oral Implantology

      Diplomate, Taiwan Head & Neck (Oncology) Society

      Fellow, International Association of Oral & Maxillofacial Surgeons

      Fellow, Asian Association of Oral & Maxillofacial Surgeons 

      Fellow, International College of Dentists

Clinical Specialties & Research Interests︰

Orthognathic Surgery︰

    Dento-facial Deformities

    Obstructive Sleep Apnea

    Complicated Implant Related Surgery︰

        Bone Block Grafting for Ridge Augmentation

        Sinus Elevation & Subantral Augmentation

        Simultaneous Implantation and Tent Pole Grafting

        Guided Bone Regeneration

        Soft Tissue Augmentation

    Oral & Maxillofacial Trauma

    Temporal Mandibular Disorders

        TransOral Approach for TMJ ankylosis

    Autogenous Bone Graft Harvesting from

        Tibial Plateau

        Anterior Iliac Crest

        IntraOral Donor Sites

    Reconstruction of Jaw Bone Continuity Defects

Recent Publication :

(1)  Intraoral Approach for Arthroplasty for Correction of TMJ Ankylosis(2009)

(2)Treatmnet of large jaw bone cysts in children(2009)

(3)Effects of Elasticity and Structure of Trabecular Bone on the Primary

Stability of Dental Implants(2010)

(4)Biomechanical simulation of various surface roughnesses and

geometric designs on an immediately loaded dental implant(2010)

(5)Association Between the Hypoxia Inducible Factor-1α Polymorphisms

and the Tumor Size of Oral Squamous Cell Carcinoma(2011)

(6)Lysyl Oxidase Enhances Cell Proliferation and Angiogenesis in Oral

Squamous Cell Carcinoma(2012)

(7)Incidence and clinical significance of zygomaticomaxillary complex

fracture involving the temporomandibular joint with emphasis on

trismus(2012)

(8)Three-dimensional bone structure and bone mineral density

evaluations of autogenous bone graft after sinus augmentation: a

microcomputed tomography analysis(2012)

(9)Epigallocatechin gallate sensitizes CAL-27 human oral squamous cell

carcinoma cells to the anti-metastatic effects of gefitinib (Iressa) via

synergistic suppression of epidermal growth factor receptor and

matrix metalloproteinase-2(2012)

(10) AKT serine/threonine protein kinase modulates bufalin-triggered

intrinsic pathway of apoptosis in CAL 27 human oral cancer

cells(2012)

(11) Predicting cortical bone strength from DXA and dental cone-beam

CT(2012)

(12) Relation between insertion torque and bone-implant contact

percentage: an artificial bone study(2012)

(13) Microcomputed tomography analysis of particular autogenous bone

graft in sinus augmentation at 5 months: Differences on bone mineral density and 3D trabecular structure(2013)

(14) Biomechanical investigation on thread designs and interfacial

conditions of zirconia and titanium dental implants with bone: 3D

numerical analysis(2013)

(15) Tibial Cancellous Bone Grafting in Jaw Reconstruction: 10 Years of

Experience in Taiwan.(2013)

(16) Curcumin-loaded nanoparticles induce apoptotic cell death through

regulation of the function of MDR1 and reactive oxygen species in

cisplatin-resistant CAR human oral cancer cells(2013)

             

(17)Trabecular bone structural parameters evaluated using dental

cone-beam computed tomography: cellular synthetic bones(2013)

(18)Antitumor effects of BI-D1870 on human oral squamous cell

carcinoma(2013)

(19)Cytocompatibility and Antibacterial Properties of Zirconia Coatings

with Different Silver Contents on Titanium(2013)

(20)Antibacterial Properties and Cytocompatibility of Tantalum Oxide

Coatings with Different Silver Contents(2013)

(21) MicroRNA-20a regulates autophagy related protein-ATG16L1 in

hypoxia-induced osteoclast differentiation(2015)

(22) Isoliquiritigenin as a cause of DNA damage and inhibitor of ATM

expression leading to G2/M phase arrest and apoptosis in oral

squamous cell carcinoma.(2015)

(23) Hinokitiol suppressed pan-histone expression and cell growth in oral squamous cell carcinoma cells(2015)

The Improvement on Swallowing Function by Wearing Denture in the Patients received Mandibular Reconstruction

Kanchu Tei,, Kazuyo Kuribayashi, Mitsunobu Ono, Toshihiko Hayashi

Hokkaido University, Sapporo, Japan

The final goal of mandibular reconstruction following segmental mandibulectomy is considered to be dental prosthetic rehabilitation. It is not clear the improvement on swallowing function by wearing denture. Six patients with mandibular reconstruction using osteocutaneous fibula free flap were included in this study covering period from 2007 to 2013. Swallowing function with or without denture was assessed in the video-fluoroscopic examination. The results suggest that wearing denture have a significant effect on swallowing function in the patients undergoing mandibular reconstruction.