Prototyping: Major Advance in Surgical Planning and Customizing Prostheses in Patients with Bone Tumors of the Head and Neck

Major resections of bone tumors of the head and neck, owing to their small dimensions and their proximity to the organs in this region, cause important functional and aesthetic problems that significantly compromise patients’ quality of life. Therefore, therapeutic planning should always extend beyond the resection to include functional and aesthetic reconstruction, preferably immediately. Microsurgical reconstruction represents a significant advance, but has not yet been perfected. Rapid prototyping (RP) comes as a new technology for the purpose of assisting the surgeon in the visual and tactile aspects of surgery, providing diagnostic accuracy and increasing the success of surgical planning. The authors demonstrate the technological advances in the manufacture of customized mandibular prostheses with the assistance of RP and practical applications of these methods.

ANALYSIS OF 26,826 PATIENTS WITH TUMORS IN THE HEAD AND NECK

A series of 26,826 patients with head and neck tumer as confirmed by pathology from January 1970 to December 1989 are analyzed. It accounted for 39. 5% of all the tumors blopsied in the same interval. In this series, 72. 4% was malignant which accounted for 45. 77% of malignant tumors in different parts of the whole body. For benign tumors in the head and neck, the ratio of male to female was 0. 84:1, and for malignant tumors In the head and neck it was 2. 4:1. The most frequently involved site by the malignant tumors were :nasopharynx, mouth, maxillofacial regions, and neck. THe majority (62. 65%) of malignant tumors were located in the nasopharynx which accounted for 28. 68% of all malignanties of which the ratio of mate and female was 3:1, peak age was 41-50 years, 18 of themwas under 10 years of age, the youngest was 1 1/2 years andthe oldest was 84 years old. These data showed that malignant tunors in the head and neck regions, expecially those in the nasopharynx, are common in Guanxi province, China. The program for cancer research on prevention and treatment should be enforced.

Research Progress in Surgical Management of Head and Neck Tumors Involving the Carotid Artery

The surgeons adopt the comprehensive treatment method basing on surgery When head and neck tumors involve the carotid artery. At present, there are four surgical treatments, namely, dissection of carotid artery tumor, resection of carotid artery, revascularization after carotid resection, endoarterial implantation of covered stent combined with surgical resection. However, there is currently no consensus on the standard surgical approach to choose. This paper describes the four surgical methods, which are expected to be helpful for head and neck surgeons to choose the surgical methods for head and neck tumors involving the carotid artery.

MANAGEMENT OF HEAD AND NECK TUMORS

The experience of management of head and neck tumors was summarized by author’s and some other Chinese literatures. This paper mainly introduced the epidemiology, diagnosis, treatment and prognosis of head and neck tumors, especially the malignancies in China. It emphasized that to assign protocols on a case-by-case basis (custom made) and the combined therapy are key points to improve the cure rate or survival rate for head and neck malighancies. Up to now, the 5-year survival rate for squamous cell carcinoma of head and neck was about 62% (1986), and about 71% (1987) for carcinoma of salivary gland origin.

A CLINICAL ANALYSIS OF 7878 PATIENTS WITH TUMORS IN THE HEAD AND NECK

7878 patients with tumors in the head and neck were analyzed in a period of twenty years. All the diagnosis were confirmed by pathologic examination. There were 5485 cases (69.62%) of malignant tumors. Nearly an half of malignant tumors were in the nasopharynx (49.32%). Among the malignant tumors of the nasopharynx, 2698 were carcinoma (99.34%) and only 18 (0.66%) sarcoma. Nine of them were under 10 years of age, the youngest patient was 3 years old, and this is rare in our county. The incidence of head and neck tumors was 37.66% and that of the head and neck malignancies was 26.22% of tumors in the whole body. This study indicates that incidence of malignant tumor in head and neck was rather higher, it is worth to improve ths procedure of treatment and prevention.

Clinicopathological and Prognostic Significance of Circulating Tumor Cells in Patients with Head and Neck Cancer: A Meta-Analysis

Purpose: The aim of the study was to evaluate the association between clinicopathological and prognostic significance and circulating tumor cells (CTCs) in patients with head and neck cancer. Methods: We searched PubMed, MEDLINE, BioMed, and EMbase databases for studies that assessed the association between clinicopathological and prognostic significance and CTCs in patients with head and neck cancer. Studies obtained from search strategy were screened using pre-specified criteria, and necessary data were retrieved for meta-analysis. Results: Seventeen studies with 816 patients were eligible for combined analysis. Presence of CTCs in peripheral blood was significantly associated with N stage (OR 0.50, 95%CI [0.30, 0.81], n = 10, P = 0.005). Patients in the high-CTC group were significantly associated with poorer disease-free survival (DFS;HR = 1.73, 95%CI [1.01 - 2.96], P = 0.050) and poorer overall survival (OS;HR = 2.53, 95%CI [1.37 - 4.69] P = 0.003). Further analyses indicated strong prognostic powers of CTCs in non-RT-PCR group and pre-treatment group. Conclusion: Our meta-analysis indicates that presence of CTCs is associated with higher N stage and poorer prognosis in patients with head and neck cancer. The potential for further clinical application may be needed for further investigation.Purpose: The aim of the study was to evaluate the association between clinicopathological and prognostic significance and circulating tumor cells (CTCs) in patients with head and neck cancer. Methods: We searched PubMed, MEDLINE, BioMed, and EMbase databases for studies that assessed the association between clinicopathological and prognostic significance and CTCs in patients with head and neck cancer. Studies obtained from search strategy were screened using pre-specified criteria, and necessary data were retrieved for meta-analysis. Results: Seventeen studies with 816 patients were eligible for combined analysis. Presence of CTCs in peripheral blood was significantly associated with N stage (OR 0.50, 95%CI [0.30, 0.81], n = 10, P = 0.005). Patients in the high-CTC group were significantly associated with poorer disease-free survival (DFS;HR = 1.73, 95%CI [1.01 - 2.96], P = 0.050) and poorer overall survival (OS;HR = 2.53, 95%CI [1.37 - 4.69] P = 0.003). Further analyses indicated strong prognostic powers of CTCs in non-RT-PCR group and pre-treatment group. Conclusion: Our meta-analysis indicates that presence of CTCs is associated with higher N stage and poorer prognosis in patients with head and neck cancer. The potential for further clinical application may be needed for further investigation.

Different imaging techniques in the head and neck:Assets and drawbacks

In this review,the gold standard imaging techniques for the head and neck and the latest upcoming techniques are presented,by comparing computed tomography(CT),magnetic resonance imaging and positron emission tomography-CT,as well as ultrasound,depending on the examined area.The advantages and disadvantages of each examination protocol are presented.This article illustrates the connection between the imaging technique and the examined area.Therefore,the head and neck area is divided into different sections such as bony structures,nervous system,mucous membranes and squamous epithelium,glandular tissue,and lymphatic tissue and vessels.Finally,the latest techniques in the field of head and neck imaging such as multidetector CT,dual-energy CT,flash CT,magnetic resonance angiography,spectroscopy,and diffusion tensor tractography using 3 tesla magnetic resonance are discussed.

Clinicopathological and molecular insights into odontogenic tumors associated with syndromes:A comprehensive review

The association between genetic syndromes and odontogenic tumors encompasses several entities,reflecting the intricate interplay between genetic factors and the development of these lesions.The present study aimed to comprehensively investigate the associations between genetic syndromes and odontogenic tumors.We delineated the diverse spectrum of syndromic connections,including key syndromes such as Gardner syndrome,Gorlin syndrome,Schimmelpenning syndrome,and others.Our findings underscore the clinical significance of recognizing odontogenic tumors associated with genetic syndromes as diagnostic indicators for early intervention.We advocate for multidisciplinary collaboration among clinicians,geneticists,and researchers to deepen our understanding of the underlying mechanisms driving these syndromic associations.In light of this,our study contributes to the growing body of knowledge in dentistry and medical genetics,offering insights that may inform clinical practice and enhance patient care for individuals affected by genetic syndromes and odontogenic tumors.

卡瑞利珠单抗和化疗联合阿帕替尼救治性治疗复发或晚期头颈鳞癌的疗效分析

目的观察卡瑞利珠单抗和化疗联合阿帕替尼救治性治疗复发或晚期头颈鳞癌(HNSCC)的疗效及安全性。方法回顾性分析2020年3月至2021年11月徐州市中心医院口腔科收治的8例复发或晚期HNSCC病人,予卡瑞利珠单抗和化疗行2周期治疗后,待瘤体缩小,卡瑞利珠单抗和阿帕替尼维持性治疗;主要观察指标为疾病控制率(DCR)和客观缓解率(ORR),次要观察指标为总生存期(OS)、无进展生存时间(PFS)和不良反应发生率。结果纳入8例复发/晚期HNSCC病人中,ORR为62.5%(5/8),DCR为87.5%(7/8)。随访时间为1~32个月,中位OS为18个月,中位PFS未达到,不良反应发生率为100%,但程度较轻。结论卡瑞利珠单抗和化疗联合阿帕替尼治疗复发或晚期HNSCC病人具有较好的疗效,能够有效控制疾病进展,提高病人生存质量。

脂肪间充质干细胞来源外泌体改善放射性口腔黏膜炎

背景:头颈肿瘤放疗极易引起放射性口腔黏膜炎,严重影响患者的健康及肿瘤的治疗计划。间充质干细胞在多种疾病中表现出治疗潜力,外泌体是其发挥功能的重要因素之一。目前尚无脂肪间充质干细胞来源外泌体应用于放射性口腔黏膜炎的相关研究。目的:探讨脂肪间充质干细胞来源外泌体在放射性口腔黏膜炎中的作用。方法:提取脂肪间充质干细胞及脂肪间充质干细胞来源外泌体并进行鉴定。通过3 Gy X射线辐射口腔黏膜上皮细胞诱导放射性口腔黏膜炎体外模型,在造模前给予脂肪间充质干细胞或脂肪间充质干细胞来源外泌体预处理48 h,EdU实验和克隆形成实验检测口腔黏膜上皮细胞的增殖能力。通过3 Gy X射线辐射构建放射性口腔黏膜炎小鼠模型,将脂肪间充质干细胞和脂肪间充质干细胞来源外泌体分别注入放射性口腔黏膜炎小鼠尾静脉,采用苏木精-伊红染色和免疫组化评估口腔黏膜上皮组织的炎症变化。结果与结论:(1)与对照组相比,脂肪间充质干细胞及脂肪间充质干细胞来源外泌体均可促进口腔黏膜上皮细胞克隆形成,增加口腔黏膜上皮细胞EdU阳性率;(2)脂肪间充质干细胞及脂肪间充质干细胞来源外泌体均能够缓解辐射处理小鼠口腔黏膜上皮组织的炎症;口腔黏膜上皮组织中CD45阳性细胞均减少,PCNA阳性细胞均增加。结果表明,脂肪间充质干细胞来源外泌体可促进口腔黏膜上皮细胞增殖,对放射性口腔黏膜炎小鼠口腔黏膜炎症具有缓解作用。

头颈肿瘤围术期静脉血栓栓塞症防治中国专家共识

静脉血栓栓塞症(venous thromboembolism, VTE)是外科术后常见并发症和医院内非预期死亡的重要危险因素,也是恶性肿瘤患者的第二大死亡原因。晚期头颈部恶性肿瘤患者通常需要接受大范围的肿瘤根治手术和同期修复重建手术,又由于高龄兼长时间手术、术后长时间卧床以及肿瘤和化疗药物导致的血液高凝状态等多种危险因素,提示头颈部恶性肿瘤患者应是VTE的极高危群体,但相关文献对头颈部恶性肿瘤患者的VTE发生情况却很少关注,有关VTE在头颈肿瘤术后发生率的数据也有限。迄今为止,国内对于头颈肿瘤围术期静脉血栓栓塞症缺乏相关治疗共识或指南,不同单位对于头颈肿瘤围术期静脉血栓栓塞症的预防与管理水平参差不齐,缺乏统一、科学的诊疗标准及客观的预防与管理评价体系。为统一和规范头颈肿瘤围术期静脉血栓栓塞症的诊治,减少医疗资源浪费,提高治疗效果,国内该研究领域的专家经反复讨论,汇集全国14家著名医学院校及附属医院专家的诊治意见,同时借鉴和参考国内外近年来对头颈肿瘤围术期静脉血栓栓塞症的研究成果与诊治经验,制订本专家共识,供相关临床医师参考。

Primary Cutaneous Apocrine Carcinoma of the Neck Involving the Parotid Gland: A Case Report and Review of the Literature

Introduction: Primary cutaneous apocrine carcinoma (PCAC) is a rare skin malignant tumor that originates from areas with a high concentration of apocrine glands. The incidence of PCAC in the neck is relatively low. The age of onset in PCAC ranges from 5 to 70 years old. Clinically, PCAC typically shows up as painless nodules or lumps. In immunohistochemistry, positive expression of CK-7, GCDFP-15, AR, and myoepithelial markers are helpful in the diagnosis of PCAC. This case report pertains to a 59-year-old male of Asian descent. Five years ago, a painless mass was discovered behind his right ear, which grew slowly. This patient was identified as PCAC based on clinical symptoms, pathology, immunohistochemistry, and imaging characteristics. PCAC involved the parotid gland in this case;it is easy to be misdiagnosed as a primary malignant tumor of the parotid gland on imaging. Furthermore, a thorough set of clinical, imaging, pathological, and immunohistochemical examinations must be performed to make a diagnosis because it is challenging to differentiate PCAC from metastatic breast carcinoma. Conclusion: A well-developed multidisciplinary examination is essential because PCAC can be challenging to diagnose and differentiate.

小檗碱抗脑瘤和头颈部肿瘤的药理作用研究进展

小檗碱具有广泛的药理活性,除抗炎、抗感染、降血糖、调血脂、心脏保护等作用外,对胃癌、乳腺癌、膀胱癌、肝癌等还具有显著的抗肿瘤作用,是一个潜在的抗肿瘤药物。该文主要围绕小檗碱对甲状腺癌、鼻咽癌、口腔鳞癌、舌癌、喉癌、腺样囊性癌等头颈部肿瘤和脑癌的药理作用及其机制进行了综述和分析,为小檗碱的后续开发提供理论支撑。

6D治疗床辅助影像引导下放射治疗头颈部肿瘤摆位误差分析

目的:评估锥形束CT(cone-beam CT,CBCT)引导下头颈部肿瘤调强放射治疗(intensity-modulated radiation therapy,IMRT)的分次内和分次间摆位偏差,以及6D治疗床(HexaPOD evo RT 6D)对这些偏差的纠正能力和稳定性。方法:选择北京大学第三医院肿瘤放疗科2019年5月至2022年4月头颈部肿瘤患者的病例资料进行回顾性分析,利用医科达公司AXESSE医用直线加速器进行前置CBCT扫描,通过骨窗模式与计划参考影像进行配准,自动或手动调整6D治疗床以校准偏差,随后进行第二次CBCT扫描以确认偏差校正。通过比较校正前后的配准结果,记录患者在平移(X、Y、Z方向)和旋转(Rx、Ry、Rz方向)上的摆位误差,并对分次间及分次内的摆位误差进行分析。结果:在连续入组59例患者的506次CBCT扫描中,成功获取并在线校正了6D治疗床的摆位误差数据,校正前后摆位误差的最大值分别为0.90 cm与0.04 cm(X方向)、1.74 cm与0.09 cm(Y方向)、1.80 cm与0.09 cm(Z方向),以及2.90°与0.14°(Rx方向)、3.00°与0.15°(Ry方向)、3.00°与0.15°(Rz方向)。在线校正明显减小了各方向上的平均摆位误差,平移误差(X、Y、Z方向)和旋转误差(Rx、Ry、Rz方向)的平均值分别从0.18 cm、0.22 cm、0.25 cm和0.82°、1.11°、0.73°减少至0.01 cm、0.01 cm、0.01 cm和0.04°、0.06°、0.04°(P均<0.001)。校正后,在X、Y、Z方向上平移误差小于0.10 cm的频率分别达到99.60%、98.62%、95.45%,旋转误差小于0.20°的频率均达到或超过99.80%。结论:结合CBCT和6D治疗床的在线校正显著降低了头颈部放疗患者的平移和旋转摆位误差,极大提高了治疗的精准度。

头颈部恶性肿瘤患儿放化疗所致口腔黏膜炎的护理策略

目的通过有效的护理对策降低头颈部肿瘤患儿放化疗所致口腔黏膜炎(OM)的严重程度。方法选取2020年1月—2022年12月北京同仁医院儿科收治头颈部恶性肿瘤放化疗OM患儿,儿童口腔评估指南量表评分为9-16分的中度OM患儿100例,随机分为对照组和干预组,每组各50例,对照组根据医嘱用药,干预组在医嘱用药基础上加用(0-4)℃的0.9%生理盐水指导患儿在进食后、睡前、呕吐后、口腔黏膜炎用药前10分钟,利用双侧颊部运动形成水压涡流含漱,每次含漱口液10-15 mL,漱口≥30 s。干预3天后应用儿童口腔评估指南量表进行比较两组患儿口腔黏膜的严重程度及愈合时间、痛苦程度对比。结果干预组较对照组OM的严重程度明显减轻(χ^(2)=12.398,P=0.00);OM导致的痛苦程度干预组较对照组明显减轻(χ^(2)=5.263,P=0.02);OM愈合时间干预组较对照组明显短(χ^(2)=8.752,P=0.01)。结论儿童头颈部恶性肿瘤放化疗后口腔炎用生理盐水清洁口腔能明显降低OM的严重程度;减轻OM导致的痛苦;提高药物的治疗效果缩短OM的病程,具有临床推广价值。

尼妥珠单抗联合放化疗治疗局部晚期头颈部恶性肿瘤的临床效果

目的分析局部晚期头颈部恶性肿瘤实施尼妥珠单抗+放化疗治疗的价值。方法选取滕州市中心人民医院于2021年11月—2022年11月收治的72例局部晚期头颈部恶性肿瘤患者为研究对象,依掷骰子分为基础组和综合组,每组36例,基础组行放化疗,综合组加用尼妥珠单抗,对比两组的近远期疗效和不良反应。结果综合组的临床缓解率(58.33%),和临床控制率(88.89%)均高于基础组(30.56%、66.67%),差异有统计学意义(χ^(2)=5.625、5.143,P=0.018、0.023)。随访1年后综合组生存率(80.56%)高于基础组(58.33%),差异有统计学意义(P<0.05)。两组各项不良反应反应率比较,差异无统计学意义(P>0.05)。结论放化疗时辅以尼妥珠单抗治疗不会增加不良反应,且能维持高缓解率和控制率,提升远期生存率,适用于局部晚期头颈部恶性肿瘤患者。

立体定向放射治疗在复发/转移性头颈部肿瘤治疗中的应用进展

近年来,立体定向放射治疗(SBRT)在复发/转移性头颈部肿瘤治疗中取得了显著进展。与传统的放疗相比,SBRT的治疗精度更高、副作用更小。SBRT对患者造成的创伤更小,且治疗后患者的生活质量更高。目前临床上对于复发/转移性头颈部肿瘤的治疗方法良莠不齐,多周期长疗程的化疗、化疗联合免疫治疗、手术治疗、再程放疗、同步放化疗均未能获得满意的治疗效果。SBRT为复发/转移性头颈部肿瘤患者提供了新的治疗选择,在减轻不良反应的同时提高了肿瘤的局部控制率,但SBRT在治疗过程中仍存在一定的局限性。未来,随着医学技术的不断进步和研究的深入,相信SBRT将在治疗复发/转移性头颈部肿瘤中发挥更大的作用。

喉癌患者社会疏离感现状及其影响因素

目的调查喉癌患者社会疏离感现状并分析其影响因素。方法选取郑州市某三甲医院2023年1—12月收治的219例喉癌患者,采用一般疏离感量表、自我感受负担量表、疾病接受度量表和家庭关怀指数问卷对患者进行调查。采用多重线性回归分析喉癌患者社会疏离感影响因素。结果喉癌患者社会疏离感得分(41.96±7.27)分。多重线性回归分析结果显示,年龄、性别、疾病接受度总分、自我感受负担总分及家庭关怀度总分是喉癌患者社会疏离感的影响因素(P<0.05),共解释总变异64.9%。结论喉癌患者社会疏离感处于中等水平。医护人员应重点关注年轻、女性、疾病接受度低、自我感受负担重、家庭关怀度低的患者,采取个性化干预措施减轻患者的社会疏离感。

多学科诊疗模式下翻转课堂在头颈肿瘤临床教学中的应用

目的探讨多学科诊疗(multidisciplinary diagnosis and treatment,MDT)模式下翻转课堂在头颈肿瘤临床教学中的应用效果。方法于2022年9月—2023年3月选取重庆医科大学附属第一医院耳鼻咽喉头颈外科2020年9月、2021年9月及2022年9月入学的36名专业学位研究生,采用随机数字表法分为对照组和试验组,每组各18名。对照组采用传统的教学模式,试验组采用MDT模式下翻转课堂教学模式。教学完成后,采用试卷答题的形式评价2组的知识点掌握情况,通过问卷调查形式完成学生对教学模式的满意度的评价。结果试验组的理论成绩[(40.22±4.43)分]、临床病例分析成绩[(36.11±4.34)分]均高于对照组[(41.11±3.43)分、(34.22±4.30)分],差异有统计学意义(P<0.05)。试验组的自主学习能力[(88.06±5.10)分]、主动参与感[(88.61±4.00)分]、团队协作能力[(89.78±3.57)分]、医患沟通能力[(87.44±5.20)分]、创新实践能力[(82.83±4.21)分]、临床思维能力[(89.83±3.45)分]、理论联系实践能力[(88.28±3.67)分]、教学模式满意度[(91.00±3.51)分]、对带教老师的满意度[(90.33±4.36)分]、学习兴趣[(90.22±3.44)分]等方面的评分均高于对照组[(67.39±5.79)分、(71.44±4.07)分、(66.06±5.15)分、(78.61±4.57)分、(71.50±3.67)分、(67.89±4.23)分、(67.89±3.48)分、(78.72±4.75)分、(80.56±4.89)分、(80.94±2.30)分],差异有统计学意义(P<0.05)。结论MDT模式下翻转课堂在头颈肿瘤临床教学中的教学效果良好,能够充分调动学生的主观能动性,培养学生的自主学习能力。

容积旋转调强放疗计划中优化分组角度对头颈部单、双侧靶区的影响

目的:研究Monaco计划系统中优化分组角度(increment of gantry,INC)对容积旋转调强放疗(volumetric modulated arc therapy,VMAT)计划的影响,为肿瘤放射治疗的计划优化参数提供参考。方法:选择2022年1月—12月上海交通大学医学院附属第九人民医院收治的需术后放疗的腮腺癌和舌癌患者各15例。其中,舌癌组采用双侧照射,腮腺癌组采用单侧照射。除更改Inc参数外,同一病例的计划设计参数均不改变,计划剂量优化结果要求达到临床使用要求。分别采用20、25、30、35、40优化分组角度进行对比,并以30的优化分组角度所做出的计划作为参考计划。统计并比较靶区的体积剂量D98%、D5%和D2%,以及适形度指数(conformity index,CI)与均匀性指数(homogeneity index,HI)。比较不同Inc参数计划导致的危及器官体积剂量参数和计划跳数。采用SPSS 22.0软件包对数据进行统计学分析。结果:双侧照射的舌癌组计划结果显示,Inc参数设置为30时,靶区的归一性更好。与对照组相比,其余Inc参数计划的靶区HI均有统计学意义;除Inc35计划外,其余CI均有统计学差异。危及器官方面,除左侧腮腺外,右侧腮腺、喉选择优化角度为30的效果最佳(P<0.05),左侧腮腺则20和35的效果最佳(P<0.05)。单侧照射的腮腺癌组计划结果显示,优化角度选择为30时表现更佳,靶区的归一性更好。HI评价结果存在统计差异(P<0.05),同侧中耳Inc为20,25表现较为优秀(P<0.05),喉组织角间距为20、25、40时结果更为优秀(P<0.05),下颌骨角间距为25时表现最为优秀(P<0.05),脊髓、脑干以及对侧腮腺无显著差异。所有计划的跳数随着Inc的增大而减小,单侧照射和双侧照射计划跳数均无统计学差异。结论:容积旋转调强放疗计划优化角度需要根据照射范围和肿瘤类型进行合理选择,Inc默认值30在双侧照射的舌癌靶区计划表现出更多优势;但对于单侧照射的腮腺肿瘤,除靶区存在一定优势外,其他优势并不明显。