Role of buccal mucosa graft ureteroplasty in the surgical management of pyeloplasty failure

Objective:Secondary pyeloplasty for recurrent ureteropelvic junction obstructions may be a safe and feasible surgical option for patients.This study aimed to demonstrate outcomes of utilizing a non-transecting buccal mucosa graft ureteroplasty for management of recurrent ureteropelvic junction obstruction after prior failed pyeloplasty.Methods:We performed a retrospective review of our Collaborative of Reconstructive Robotic Ureteral Surgery database for all consecutive patients who underwent buccal mucosa graft ureteroplasty between April 2012 and June 2022 for management of recurrent ureteropelvic junction obstructions after prior failed pyeloplasty.The primary outcome included surgical success which was defined as the absence of flank pain and no obstruction on imaging.Results:Overall,ten patients were included in our analysis.The median stricture length was 2.5(interquartile range[IQR]1.8-4.0)cm.The median operative time was 230.5(IQR 199.5-287.0)min and median estimated blood loss was 50.0(IQR 28.8-102.5)mL.At a median follow-up of 10.3(IQR 6.2-14.8)months,80%of patients were surgically successful and there were no major(ClavieneDindo Grade>2)complications.Conclusion:Buccal mucosa graft ureteroplasty is a valuable non-transecting surgical option for patients with recurrent ureteropelvic junction obstructions who failed prior pyeloplasty and has comparable outcomes to the literature regarding standard transecting techniques.

Tunica albuginea versus buccal mucosa graft urethroplasty for anterior urethral stricture: A prospective randomised pilot study

Objective:The objective of the study was to compare the outcome of tunica albuginea urethroplasty(TAU)and buccal mucosa graft(BMG)urethroplasty for anterior urethral stricture.Methods:Thirty patients who met the inclusion criteria were randomised into two groups:TAU(Group A)and BMG urethroplasty(Group B).Surgical outcome was evaluated with pre-and post-operative work-up involving retrograde urethrogram,voiding cystourethrogram,uroflowmetry,and urethroscopy.Patients were followed up till 1 year.Results:Mean duration of surgery was statistically significant between two groups(p=0.0005).Maximum urine flow rate was comparable when compared between two groups(p=0.22)but statistically significant when compared pre-and post-operatively(p<0.001).At follow-up of 1 year,the successful outcomes were 80% in Group A and 87%in Group B.A total of five patients who had unsuccessful results required redo urethroplasty.Complications were minimal in both the groups.Conclusion:TAU provides outcomes equivalent to those of BMG urethroplasty.TAU has less operative time,easy to perform,and beneficial in patients with poor oral hygiene.

Diverticulum of the buccal mucosa: A case report

BACKGROUND A diverticulum is the medical or biological term for outpouching of a hollow structure in the body.It particularly occurs in the digestive system,but rarely occurs in the oral mucosa.CASE SUMMARY This report describes a rare case of diverticulum presenting in the buccal mucosa in a 44-year-old woman that was initially diagnosed in Stomatology Hospital,Wuhan University.We made our diagnosis under the guidance of imaging data,and the patient underwent surgical resection.CONCLUSION This report is the first confirmed case of buccal mucosal diverticulum.in addition,we elucidated that in general,idiopathic developmental abnormalities caused by succinate muscle defects are responsible for diverticulum development.

Formulation of unidirectional release buccal patches of carbamazepine and study of permeation through porcine buccal mucosa

Objective:To achieve transbuccal release of carbamazepine by loading in unidirectional release mucoadhesive buccal patches.Methods:Buccal patches of carbamazepine with unidirectional drug release were prepared using hydroxypropyl methyl cellulose,polyvinyl alcohol,polyvinyl pyrrolidone and ethyl cellulose by solvent casting method.Water impermeable backing layer(Pidilite?Biaxially-oriented polypropylene film)of patches provided unidirectional drug release.They were evaluated for thickness,mass uniformity,surface pH and folding endurance.Six formulations FA2,FA8,FA10,FBI,FB14 and FB16(folding endurance above 250)were evaluated further for swelling studies,ex vivo mucoadhesive strength,ex vivo mucoadhesion time,in vitro drug release,ex vivo permeation,accelerated stability studies and FTIR and XRD spectral studies.Results:The ex vivo mucoadhesion time of patches ranged between 109 min(FA10)to 126 min(FB14).The ex vivo mucoadhesive force was in the range of 0.278 lo 0.479 kg/m/s.The in vitro drug release studies revealed that formulation FA8 released 84%and FB16 released 99.01%of drug in140 min.Conclusions:The prepared unidirectional buccal patches of carbamazepine provided a maximum drug release within specified mucoadhesion period and it indicates a potential alternative drug delivery system for systemic denvery of carbamazepine.

Tobacco Exposed Buccal Mucosa Graft—A Potential Carcinogen for Scrotal Cancer

Squamous cell carcinoma of scrotum is not common. It was the first cancer directly associated with a specific occupation i.e. chimney sweeps. We report a case of squamous cell carcinoma of scrotum developed in a patient of stricture urethra with multiple perineal urinary fistulas treated with lay open urethra with buccal mucosal graft. Tobacco exposed buccal mucosa graft can act as a carcinogen for scrotal cancer in patients with multiple fistula and poor hygiene.

Effects of 4-(3-Chloro-Benzyl)-6,7-Dimethoxy-Quinazoline on Kinetics of P120-Catenin and Periplakin in Human Buccal Mucosa Squamous Carcinoma Cell Line

In order to detect molecular markers for the epidermal growth factor inhibitor 4-(3-chloro-benzyl)- 6,7-dimethoxy-quinazoline (tyrphostin), we investigated the kinetics of p120-catenin and periplakin in the human buccal mucosa squamous cancer cell line BICR 10 treated with 3 nM tyrphostin. Growth of BICR 10 cells was inhibited by treatment with tyrphostin. Although changes were not observed in the expression of EGFR and p120-catenin, expression of Akt, Src and periplakin in BICR 10 treated with 3 nM tyrphostin tended to decrease. In addition, phosphorylation of EGFR, Akt and Src was inhibited by treatment with tyrphostin. On immunocytochemical staining, immunoreactions with phosphorylated EGFR, phosphorylated Akt and phosphorylated p120-catenin were weak in BICR 10 treated with tyrphostin. There was a slight immunocy to chemical reaction to periplakin in BICR 10 cells induced by tyrphostin. In conclusion, the decrease in phosphorylation in EGFR and p120-catenin by tyrphostin, following the decrease in Src or Akt phosphorylation, may inhibit expression of several growth factors associated with the proliferation and migration of cancer cells.

Histopathological changes of free buccal mucosa and colonic mucosa grafts after translation to dog bladder

Over the past years, more cases using buccal mucosa for urethral reconstruction have been reported.(1-4) The excellent early results with this tissue led some authors to extend their indications for its use. However, patients with complex, long-segment urethral strictures and significant scar tissue formation after the failure of previous urethroplasty, still present an operative challenge. The buccal mucosa may not be useful for the treatment of the complicated lengthy urethral strictures because of limited material. To explore the possibility of urethral reconstruction with a graft of colonic mucosa for the treatment of complicated lengthy strictures, we investigated the use of colonic mucosa as a novel substitute for urethral reconstruction in dogs with severe lengthy urethral structure.(5,6) The objects of the present study were to investigate further whether the colonic mucosal graft is an ideal substitute material, for urethral reconstruction, in place of buccal mucosal graft and their pathological characteristic after long-term exposure to urine.

A comparative study of buccal mucosa graft and penile pedical flap for reconstruction of anterior urethral strictures

Anterior urethral strictures, where the length is more kthan 2 cm, are best treated by substitution urethroplasty with either preputial/penile skin flaps or free grafts.1 The use of dartos pedicled flaps has many advantages in terms of increased survival thanks to its own vascularization. Recently, buccal mucosa has become increasingly popular among urologists for urethral replacement when local penile skin is unavailable. Both penile skin flaps and buccal mucosa grafts have emerged as reliable urethral substitutes with comparable long-term results. These urethral substitutes are traditionally placed on the ventral aspect of the stricture and have a success rate of about 85%.

Tissue expander capsule as an induced vascular bed to prefabricate an axial vascularized buccal mucosa-lined flap for tubularized posterior urethral reconstruction: preliminary results in an animal model

Surgical repair of complex posterior urethral disruptions remains one of the most challenging problems in urology.The efficacy of using a tissue expander capsule as an induced vascular bed to prefabricate axial vascularized buccal mucosa-lined flaps for tubularized posterior urethral reconstruction in a rabbit model was tested.The experiments were performed in three stages.First,silicone tissue expanders were inserted into the groin to induce vascularized capsule pouch formation.Next,buccal mucosa grafts were transplanted into the newly formed capsular tissue supplied by axial vessels for buccal mucosa-lined flap prefabrication.Then,circumferential posterior urethral defects were created and repaired with the buccal mucosa graft(Group 1),the capsule flap(Group 2),and the prefabricated capsule buccal mucosa composite flap(Group 3).After surgery,notable contracture of the tubularized buccal mucosa graft was observed in the neourethra,and none of the rabbits in Group 1 maintained a wide urethral caliber.In Group 2,the retrieved neourethra showed little evidence of epithelial lining during the study period,and the lumen caliber was narrowed at the 3-month evaluation.In Group 3,the buccal mucosa formed the lining in the neourethra and maintained a wide urethral caliber for 3 months.The capsule may serve as an induced vascular bed for buccal mucosa-lined flap prefabrication.The prefabricated buccal mucosa-lined flap may serve as a neourethra flap for posterior urethral replacement.

Incidence of bone metastasis in squamous cell carcinoma of the buccal mucosa

Aim:This retrospective study was performed to show the incidence of bone metastasis from carcinoma of the buccal mucosa.Head and neck cancer is a leading health problem in India due to an increased incidence of tobacco use and poor oral hygiene.Squamous cell carcinoma of the buccal mucosa is common and roughly 2.5%of all malignancies that present to our center.Moreover,most patients present at late stages(III/IV)and consequently,survival rates are low.Bone metastasis in advanced cases of such carcinomas is rarely reported worldwide but is more prominent in parts of India.Methods:Here,we present a series of patients diagnosed with buccal mucosa carcinomas within the past 5 years that also demonstrated bone metastases.Results:These patients were young,with a history of tobacco chewing with locally advanced disease and bone metastases that developed within one year of diagnosis.Flat bones and vertebrae were mainly involved and the survival was short after diagnosis of metastasis despite treatment with local radiotherapy and chemotherapy.The cause of such frequent metastases cannot be proved but subclinical seeding of malignant cells before the eradication of the primary tumor is probable contributory with advanced local and nodal disease with high grade tumor.Conclusion:A pretreatment bone scan should be performed in locoregionally advanced buccal mucosa carcinomas at the time of diagnosis to defi ne the treatment plan.

A Case of Secretory Carcinoma That Occurred in the Buccal Submucosa

Secretory carcinoma (SC) is a malignant salivary gland tumor that has been first reported by Skalova et al. in 2010. Histologically, it shows solidity infiltrated with very small cystic cavities and cribriform and papillary features and includes periodic acid-Schiff stain-positive, acid-fast secretions. The cells have oval nuclei, and vacuolated cytoplasm and foamy secretions are seen. Anaplasia is not strong and mitotic figures are rarely seen. These features closely resemble AciCC. Immunohistologically, it is thought to be positive for S-100 protein, vimentin, and mammaglobin and negative for DOG1. The presence of the ETV6-NTRK3 fusion gene is essential in diagnosing secretory carcinoma. In this report, we describe a case of SC in a 52-year-old woman. She was referred to our center because of a mass in left buccal mucosa. A soft and elastic submucosal mass measuring approximately 10 mm × 10 mm in size with a smooth surface was seen in the buccal mucosa in an area corresponding to the left mandibular canine to premolars. The imaging findings revealed that a high-intensity lesion was seen on T2-weighted images. Immunohistochemicalstaing for S-100 protein and vimentin were positive. Furthermore, genetic examination detected the presence of the ETV6-NTRK3 fusion gene. Based on these findings, the definitive diagnosis was secretory carcinoma.

Role of the Chinese Herbal Medicine Xianhuayin on the Reversal of Premalignant Mucosal Lesions in the Golden Hamster Buccal Pouch

Aim To investigate the role of the Chinese herbal medicine Xianhuayin on the reversal of 7,12-dimethylbenz[a]anthracene （DMBA）-induced premalignant mucosal lesions in the oral buccal pouch of golden hamsters. Methodology The animals were randomly divided into a non-diseased control group （n=5） and an experimental group including 50 animals in which the buccal mucosa had been painted with DMBA （0.5% in acetone） to generate an oral mucosa premalignant lesion. Animals in the experi- mental group were further divided into Xianhuayin-treated group （n=30）, untreated prem＇alignant lesion group （n=10） and normal saline （NS）-treated group （n=10）. The cheek （buccal） pouch mucosa of the golden hamsters in each group was observed with light and electron microscopy eight weeks after intragastric administration with NS or Xianhuayin. Results In the non-diseased control group, the buccal mucosa was keratinized and stratified squamous epithelium under a light microscope. In the untreated premalignant lesion group, variable degrees of epithelial dysplasia was observed. The irregular epithelial mucosa gradually became distinct in the Xianhuayin-treated group. Scanning electronic microscopic （SEM） analysis showed that surface of the cells exhibited honeycomb structures in the hamster of untreated- group. The cells were morphologically irregular, overlapped and loosened in the untreated premalignant lesion group. Most of the cell surface exhibited honeycomb structure in the Xianhuayin-treated group. Transmission electronic micro- scopic （TEM） analysis showed that buccal mucosal epithelial cells were morphologically regular in the non-diseased control group. Desmosomes and tonofibrils were reduced and the nucleus was morphologically irregular in the untreated premalignant lesion group. In the Xianhuayin-treated group, the widening intercellular gap was gradually reduced, desmosomes and the cells becoming morphologically regular. No significant difference was observed between the hamsters in NS-treated group and those in the untreated premalignant lesion group. Significant therapeutic efficacy was observed in the group receiving Xianhuayin. Conclusion Xianhuayin is effective in the reversal of DMBA-induced premalignant lesions in the buccal pouch of golden hamsters.

Effect of Enzymes in Buccal Mucous Membrane on Buccal Absorption of Insulin

To evaluate the effect of proteolytic enzymes on the absorption of insulin in the buccal mucosa, the trichloroacetic acid (TCA) method was used to estimate the degradation of insulin under different conditions in the buccal mucosal homogenates. In vivo experiments estimating the enhancement of hypoglycaemic effect by enzyme inhibitors were also conducted. The results showed that proteolytic enzymes in the buccal mucosa were less active than in the intestine. Bacitracin, aprotinin and sodium deoxycholate could inhibit the degradation of insulin in the buccal mucosal homogenates. The degradation of insulin in buccal mucosal homogenates of normal hamsters was smaller than that of diabetic hamsters. In vivo experiments of hypoglycaemia supported the in vitro results. When given buccally, bacitracin, aprotinin and sodium deoxycholate could increase the relative pharmacological bioavailability of insulin. When co-administered with aprotinin(0.1%), bacitracin(0.5%) and sodium deoxycholate(5%), the relative pharmacological bioavailabilities of insulin were 4.84%, 6.60% and 14.95% respectively. The in vitro and in vivo results suggest that proteolytic enzymes are present in the buccal mucosa, which limit absorption of insulin. Co-administration with some enzyme inhibitors can improve the bioavailability of insulin via buccal delivery and sodium deoxycholte is more efficient than some enzyme inhibitors used for improving buccal absorption.

机器人辅助腹腔镜下颊黏膜补片输尿管成形术治疗复杂输尿管狭窄

目的:探讨机器人辅助腹腔镜下颊黏膜补片输尿管成形术治疗复杂输尿管上段、长段狭窄的可行性、安全性及有效性。方法:收集2022年7月至2023年1月于北京大学第一医院泌尿外科和北京市健宫医院泌尿外科收治的20例行机器人辅助腹腔镜下颊黏膜补片输尿管成形术治疗输尿管上段狭窄患者的临床资料,记录并分析术中情况、术后并发症及随访资料。结果:本研究包含14例男性和6例女性,平均年龄(41±11)岁(范围19~60岁),平均体重指数(24.3±3.6)kg/m^(2)(范围18.2~31.8 kg/m^(2))。左侧9例,右侧11例,所有患者的狭窄部位均位于输尿管上段(包含肾盂-输尿管连接部)。平均术前血肌酐(92.2±23.3)μmol/L(范围49.2~138.9μmol/L),平均输尿管狭窄长度为(2.8±0.9)cm(范围1.0~4.0 cm)。20例患者中10例患者既往接受过失败的重建手术,12例患者术中接受了输尿管后壁加强吻合。平均获取颊黏膜补片长度为(3.1±0.6)cm(范围2.0~4.3 cm),中位宽度为1.5 cm(范围1.0~2.0 cm)。中位手术时长154 min(范围113~300 min),中位术中估计出血量45 mL(范围0~100 mL)。中位术后住院日为4 d(范围4~14 d)。平均术后随访时间(15.0±1.7)月(范围12.5~17.9月),手术成功率为100.0%。术后11例患者报告了颊黏膜取材部位的轻度不适,2例患者术后出现泌尿系感染,其他7例没有报告术后并发症。术后6个月复查血肌酐,为(90.9±23.9)μmol/L(范围60.0~153.0μmol/L)。结论:机器人辅助腹腔镜下颊黏膜补片输尿管成形术治疗复杂输尿管上段、长段狭窄疗效满意,无严重并发症发生,具有较好的可行性、安全性和有效性,但需大样本研究及长时间随访评估其远期疗效。

输尿管狭窄常见的治疗方法

输尿管狭窄可由先天性或继发性原因引起,包括开放或内窥镜手术、结石、创伤等,其中医源性损伤是引起输尿管狭窄的主要原因,可能导致诸多后遗症如上尿路扩张和肾脏区域疼痛等。若未得到有效医治最后可致肾积水、泌尿系感染、慢性肾功能不全,甚至肾功能衰竭。输尿管狭窄的治疗对泌尿科医生来说是一个复杂的挑战,可以采用输尿管支架置入、球囊扩张等进行治疗,另外,除了上述治疗外,也可以采用输尿管端端吻合术、膀胱瓣输尿管成形术等进行狭窄修复,同时利用自体补片进行输尿管重建近年来也越来越多,并且随着腹腔镜技术的进步,泌尿外科医生可以联合腹腔镜进行输尿管修复重建,具有早日康复、减少失血和疼痛的优势。本文章就目前临床上常用的手术方式做一综述。

光动力治疗右颊黏膜疣状癌1例报道及文献回顾

目的探讨口腔疣状癌的光动力治疗方法及疗效,为临床提供参考。方法本研究遵循医学伦理学要求,对1例发生在右颊黏膜直径约2.5 cm的口腔疣状癌的光动力治疗进行总结,结合文献对口腔疣状癌的特点、治疗及口腔黏膜潜在恶性疾患的光动力治疗进行回顾性分析。结果该口腔疣状癌患者先后进行4次光动力治疗,右颊病损面积显著减小。术后随访6个月,右颊白色疣状增生完全消退,无明显瘢痕形成。术后3年,右颊病损无复发,治疗区域无明显瘢痕形成,张口度3指,双侧颌下、颏下、颈部均未触及淋巴结肿大。文献回顾表明,口腔疣状癌是一种少见的鳞状细胞癌亚型,具有生长缓慢、低度恶性、极少转移的特点,手术是首选治疗手段,但存在一定局限性。光动力治疗具有微创性、可重复操作、不良反应轻微等优势,近年来光动力治疗已逐步应用于口腔黏膜潜在恶性疾患和早期口腔鳞状细胞癌的治疗,并取得了积极结果,但尚未见用于口腔疣状癌治疗的报道。结论光动力治疗为口腔疣状癌提供了一种非手术切除的新选择。

A clinical perspective on mucoadhesive buccal drug delivery systems

Mucoadhesion can be defined as a state in which two components, of which one is of biological origin, are held together for extended periods of time by the help of interfacial forces. Among the various transmucosal routes, buccal mucosa has excellent accessibility and relatively immobile mucosa, hence suitable for administration of retentive dosage form. The objective of this paper is to review the works done so far in the field of mucoadhe- sire buccal drug delivery systems （MBDDS）, with a clinical perspective. Starting with a brief introduction of the mucoadhesive drug delivery systems, oral mucosa, and the theories of mucoadhesion, this article then proceeds to cover the works done so far in the field of MBDDS, categorizing them on the basis of ailments they are meant to cure. Additionally, we focus on the various patents, recent advancements, and challenges as well as the future prospects for mucoadhesive buccal drug delivery systems.

颊黏膜放血疗法治疗周围性面瘫的原理探讨

探究运用颊黏膜放血疗法治疗周围性面瘫的原理,通过对周围性面瘫的中医原理、颊黏膜的特殊部位及放血疗法的历史演变与机制进行探索研究。通过整理颊黏膜与周围性面瘫的关联,研究颊黏膜放血疗法对周围性面瘫的作用,更好地推动放血疗法的发展和研究,为周围性面瘫的治疗提供理论指导下的探索与发现,提供新的临床治疗思路与方法。

颊、腭粘膜移植修复硬腭裸露骨面的组织学观察

目的 :研究硬腭裸露骨面和应用颊、腭粘膜移植覆盖裸露骨创面后的组织学愈合过程。方法 :选用 32只日本大耳白纯种兔 ,随机分为正常对照组、裸露骨面组、颊粘膜移植组、腭粘膜移植组。裸露骨面组 ,用外科手术形成一恒定大小的矩形裸露骨面 ;颊、腭粘膜移植组 ,则在裸露骨面的基础上 ,分别用相同面积的颊、腭粘膜移植覆盖裸露骨面。术后定期处死动物 ,切取硬腭制作组织学切片 ,观察不同处理措施的腭部组织学愈合过程。结果 :裸露骨面组 ,术后 2周出现致密纤维结缔组织 ;术后 4周 ,软组织与骨组织之间出现Sharpey′s纤维 ,并存在至观察期结束。采用颊、腭粘膜移植组 ,结缔组织较疏松 ,无Sharpey′s纤维形成 ,组织结构类似于正常组织。结论 :采用颊、腭粘膜移植修复硬腭裸露骨面 。

多种组织瓣在口颊缺损重建中的应用

背景与目的:合理采用组织瓣进行口颊缺损重建,可以扩大口颊癌手术指征,改善患者的生存质量,延长患者生命。本研究目的是探讨组织瓣重建口颊缺损的指征,不同组织瓣的选择以及重建的手术技巧。方法:2005年9月至2007年8月间共行26例组织瓣重建口颊缺损手术,其中单纯口颊粘膜切除8例;口颊大型缺损18例,其中包括口颊面部皮肤洞穿切除11例,口颊、皮肤以及口角全缺损切除7例。26例患者中有7例行腮腺导管切除。胸大肌肌皮瓣转移重建5例,游离前臂桡侧皮瓣重建11例,游离股前外侧皮瓣6例,胸锁乳突肌肌皮瓣4例。8例患者行术后放疗,剂量为66～70Gy。结果:围术期无死亡病例,1例皮瓣坏死,为游离前臂皮瓣重建病例;1例皮瓣部分坏死,为胸大肌肌皮瓣重建病例。皮瓣成功率为96.2%(25/26)。1例伤口积液,为涎腺瘘。所有患者均随访1～3年,7例复发患者中4例为原发灶复发,3例为颈部淋巴结复发。随访期间2例患者死亡,均为原发灶局部复发者。结论:游离股前外侧皮瓣和游离前臂皮瓣是重建口颊大型缺损的良好皮瓣,是大于4cm的口颊缺损的首选;胸大肌肌皮瓣可作为口颊大型缺损重建的备用皮瓣;小于4cm的口颊缺损可选用胸锁乳突肌肌皮瓣。