WFU

2017年9月28日 星期四

From Tradition to Innovation: My Stanford Experience

From Tradition to Innovation: My Stanford Experience


Yu-Feng CHEN

1973, Professor Christian Guilleminault described a new clinical syndrome at Stanford: sleep apnea with insomnia, which named as OSA (Obstructive Sleep Apnea). 1979, at Stanford, Dr. Nelson Powell and Robert Riley started to develop sleep surgery. Then OSA patients can be treated by various surgical modalities not only by tracheotomy. The well-known Stanford sleep surgery protocol was published on 2010, which can be the treatment protocol for surgeons to follow.


I went to Stanford sleep surgery division for one year training, following Dr. Robert Riley and Dr. Stanley Yuan-Chuan Liu. From an Oral Maxillofacial surgeon staining point, I would like to share my learning experience at Stanford. Moreover, I would present the comprehensive review and the latest knowledge of sleep surgery. 

Dr. Hao-Hueng Chang

Dr. Hao-Hueng Chang





Associate Professor, School of Dentistry, National Taiwan University
Attending Surgeon, Dept. of Oral and Maxillofacial Surgery, National Taiwan University Hospital, Taiwan
Principle Investigator, Laboratory for Animal Experiment and Hard Tissue Investigation

Dr. Chang is an associate professor of School of Dentistry in National Taiwan University. He is a clinician-scientist with interest in both basic and clinical research. Current research is focused on expression of some biomarker in oral cancer, tissue engineering and in vivo testing of biomaterial including innovative or new osteo-inductive scaffold and dental implant.

Topic: Recent advances in materials and technology of dental implant

Professional Experiences:
1996-2000, Resident, Dept. of Oral and Maxillofacial Surgery, National Taiwan University Hospital.
2000~Present; Attending Surgeon, Dept. of Oral and Maxillofacial Surgery, National Taiwan University Hospital.
2004-1009 Lecturer, School of Dentistry, National Taiwan University
2009-2014 Assistant Professor, School of Dentistry, National Taiwan University
2014- Present: Associate Professor, School of Dentistry, National Taiwan University

Publications
1.      Chen YJ, Yao CC, Huang CH, Chang HH, Young TH. Hexosamine-Induced TGF-β Signaling and Osteogenic Differentiation of Dental Pulp Stem Cells Are Dependent on N-Acetylglucosaminyltransferase V. Biomed Res Int. 2015;2015:924397. doi: 10.1155/2015/924397. Epub 2015 Oct 25.
2.      Yang KC, Kitamura Y, Wu CC, Chang HH, Ling TY, Kuo TF . Tooth Germ-Like Construct Transplantation for Whole-Tooth Regeneration: An In Vivo Study in the Miniature Pig. Artif Organs. 2015 Nov 18. doi: 10.1111/aor.12630.
3.      Yang KC, Wang CH, Chang HH, Chan WP, Chi CH, Kuo TF. Fibrin glue mixed with platelet-rich fibrin as a scaffold seeded with dental bud cells for tooth regeneration. J Tissue Eng Regen Med. 2012 Nov;6(10):777-85. doi: 10.1002/term.483. Epub 2011 Oct 28.
4.      Wu TS, Tan CT, Chang CC, Lin BR, Lai WT ,Chen ST, Mark Kuo MYP, Rau CI , Jaw FH, Chang HH* ,B cell lymphoma/ leukemia 10 promotes oral cancer progression through STAT1/ATF4/S100P signaling pathway. Oncogene. 2015 Mar 5;34(10):1207-19.
5.      Wu YH, Chang JY, Chang HH, Chiang CP. Langerhans cells in a dermoid cyst epithelium lining. J Formos Med Assoc. 2016 Jan;115(1):57-8. doi: 10.1016/j.jfma.2015.08.014. Epub 2015 Oct 4.
6.      Chiang YC, Lin HP, Chang HH, Cheng YW, Tang HY, Yen WC, Lin PY, Chang KW, Lin CP. A mesoporous silica biomaterial for dental biomimetic crystallization. ACS Nano. 2014 Dec 23;8(12):12502-13. doi: 10.1021/nn5053487. Epub 2014 Dec 11.
7.      Yeh CC, Chang JZ, Yang WH, Chang HH, Lai EH, Kuo MY.NADPH oxidase 4 is involved in the triethylene glycol dimethacrylate-induced reactive oxygen species and apoptosis in human embryonic palatal mesenchymal and dental pulp cells.Clin Oral Investig. 2015 Jul;19(6):1463-71. doi: 10.1007/s00784-014-1370-7. Epub 2014 Dec 3.
8.      Chang CC, Chang KC, Tsai SJ, Chang HH, Lin CP. Neurogenic differentiation of dental pulp stem cells to neuron-like cells in dopaminergic and motor neuronal inductive media. J Formos Med Assoc. 2014 Dec;113(12):956-65. doi: 10.1016/j.jfma.2014.09.003. Epub 2014 Nov 12.
9.      Yao CC, Chang HH, Chang JZ, Lai HH, Lu SC, Chen YJ. Revisiting the stability of mini-implants used for orthodontic anchorage. J Formos Med Assoc. 2015 Nov;114(11):1122-8. doi: 10.1016/j.jfma.2014.08.001. Epub 2014 Sep 24.
10.  Wang YL, Chang CC, Chi CW, Chang HH, Chiang YC, Chuang YC, Chang HH, Huang GF, Liao YS, Lin CP. Erosive potential of soft drinks on human enamel: an in vitro study. J Formos Med Assoc. 2014 Nov;113(11):850-6. doi:
11.  Chang HH, Lee MS, Hsu YC, Tsai SJ, Lin CP.Comparison of clinical parameters and environmental noise levels between regular surgery and piezosurgery for extraction of impacted third molars. J Formos Med Assoc. 2015 Oct;114(10):929-35. doi: 10.1016/j.jfma.2014.02.003. Epub 2014 Mar 21.
12.  Chang HH, Wang YL, Chiang YC, Chen YL, Chuang YH, Tsai SJ, Heish KH, Lin FH, Lin CP.A novel chitosan-γPGA polyelectrolyte complex hydrogel promotes early new bone formation in the alveolar socket following tooth extraction.PLoS One. 2014 Mar 21;9(3):e92362. doi:10.1371/journal.pone.0092362. eCollection 2014.
13.  Wu KJ, Huang GF, Chen CH, Chang HH, Deng YT. Cyclosporine A induces connective tissue growth factor expression in human gingival fibroblasts: suppression by epigallocatechin-3-gallate. J Formos Med Assoc. 2014 Nov;113(11):828-32. doi: 10.1016/j.jfma.2014.01.008. Epub 2014 Feb 20.
14.  Lin TC, Liao YS, Lee MS, Su PY, Chen YL, Chang HH*,Lin CPOptimal Parameters of Dental Ultrasonic Instrument Diamond Coating for Enamel Removal . Journal of Dental Sciences.Volume 10, Issue 2, June 2015, Pages 128–132
15.  Wang CY, Su MZ, Chang HH, Chiang YC, Tao SH, Cheng JH, Fuh LJ, Lin CP.Tension-compression viscoelastic behaviors of the periodontal ligament.J Formos Med Assoc. 2012 Sep;111(9):471-81.
16.  Lee JJ, Cheng SJ, Wang JJ, Chiang CP, Chang HH, Chen HM, Kok SH. Factors predicting the prognosis of oral alendronate-related osteonecrosis of the jaws: a 4-year cohort study. Head Neck. 2013 Dec;35(12):1787-95. doi: 10.1002/hed.23235.  Epub 2013 Mar 18. PubMed PMID: 23508560.
17.  Chen YY, Chen WP, Chang HH, Huang SH, Lin CP. A novel dental implant abutment with micro-motion capability-Development and biomechanical evaluations. Dent Mater. 2014 Feb;30(2):131-7. doi: 10.1016/j.dental.2013.10.007. Epub 2013 Nov 14.
18.  Cheng SJ, Kok SH, Lee JJ, Yen-Ping Kuo M, Cheng SL, Huang YL, Chen HM, Chang HH*, Chiang CP. Significant association of SRC protein expression with the progression, recurrence, and prognosis of oral squamous cell carcinoma in Taiwan. Head Neck. 2012 Sep;34(9):1340-5.
19.   Chen YJ, Chung MC, Jane Yao CC, Huang CH, Chang HH, Jeng JH, Young TH. The effects of acellular amniotic membrane matrix on osteogenic differentiation and ERK1/2 signaling in human dental apical papilla cells. Biomaterials. 2012 Jan;33(2):455-63.
20.   Kuo TF, Lin HC, Yang KC, Lin FH, Chen MH, Wu CC, Chang HH. Bone marrow combined with dental bud cells promotes tooth regeneration in miniature pig model. Artif Organs. 2011 Feb;35(2):113-21
21.  Kok SH, Chang HH, Tsai JY, Hung HC, Lin CY, Chiang CP, Liu CM, Kuo MY. Expression of Cyr61(CCN1)in human oral squamous cell carcinoma: An independent marker for poor prognosis. Head Neck. 32(12): 1665-73. 2010
22.  Chang H.H., Chiang C.P., Hung H.C., Lin C.Y., Kuo Y.P. Histone Deacetylase 2 expression predicts poorer prognosis in oral cancer patients. Oral Oncology. Oral Oncol. 2009 Jul;45(7):610-4.
23.  Chang H.H. , Kuo Y.P. , Hung H.C., Lin C.Y., Chiang C.P. Expression of BCL-10 is significantly associated with the progression and prognosis of oral squamous cell carcinomas in Taiwan. Oral Oncology. 2009 Jul;45(7):589-93
24.  Lin S.K., Chang H.H., Chen Y.J., Wang C.C., Galson Deborah L , Hong C.Y., Kok S.H. Epigallocatechin-3-gallate diminishes CCL2 expression in human osteoblastic cells via up-regulation of phosphatidylinositol 3-Kinase/Akt/Raf-1 interaction: A potential therapeutic benefit for arthritis. Arthritis and Rheumatism. 58(10): 3145-3156. 2008
25.  Wang C.C., Kok S.H., Hou L.T., Yang P.J., Lee J.J, Cheng S.J., Kuo R.C., Chang H.H.* Ectopic mandibular third molar in the ramus region: Report of a case and literature review. Oral Surgery,Oral Medicine,Oral Pathology,Oral Radiology,and Endodontology. 105(2): 155-61. 2008
26.  Kuo, T.F., Huang, A.T., Chang, H.H., Lin, F.H., Chen, S.T., Chen, R.S., Chou, C.H., Lin, H.C., Chiang, H., Chen, M. H. Regeneration of dentin-pulp complex with cementum and periodontal ligament formation using dental bud cells in gelatin-chondroitin-hyaluronan tri-copolymer scaffold in swine. J Biomed Mater Res A. 86(4): 1062-1068. 2008
27.  Chang H.H., Chen Y.J., Weng C.Y., Wong W.P., Chang B.E., Chen M.H., Yao C.C. * MMP-3 Response to Compressive Forces in vitro and in vivo. J Dent Res. 87(7): 692-6. 2008
28.  Liau F.L., Kok S.H., Lee J.J., Kuo R.C., Hwang C.R., Yang P.J., Lin C.P., Kuo Y.S., Chang H.H. * Cardiovascular influence of dental anxiety during local anesthesia for tooth extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 105(1): 16-26. 2008
29.  Chen Y.H., Chang H.H., Chen Y.J., Lee D., Chiang H.H., Yao C.C. * Root contact during insertion of miniscrews for orthodontic anchorage increases the failure rate: an animal study. Clin Oral Implants Res. 19(1): 99-106. 2008
30.  Chen YJ, Chang HH, Lin HY, Lai EH, Hung HC, Yao CC. Stability of miniplates and miniscrews used for orthodontic anchorage: experience with 492 temporary anchorage devices. Clin Oral Implants Res. 19(11): 1188-1196. 2008
31.  Chen Y.J., Chang H.H., Hung H.C., Yao C.C. * A retrospective analysis of the failure rate of three different orthodontic skeletal anchorage systems. Clinical Oral Implants Research. 18(6):768-75. 2007
32.  Chang H.H.; Hahn L.J.; Yang P.B.; Hsieh B.S. Application of Levamisole in Recurrent Aphthous Ulcer: An Evidence-based Analysis. Formosan Journal of Medicine. 10(6): 752-760.2006
33.  Lai T.N., Lin C.P., Kok S.H., Yang P.J., Kuo Y.S. , Lan W.H., Chang H.H. * Evaluation of mandibular block using a standardized method. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 102(4): 462-8. 2006
34.  Chang H.H. *, Liu Y.M., Hahn L.J., Yang P.M., Hsieh B.S. Indication of Chlorhexidine (CHX) Mouthrinse: Evidence-Based Approach. Formosan Journal of Medicine. 10(4): 507-516. 2006
35.  Lee J.J., Kuo M.Y., Cheng S.J., Chiang C.P., Jeng J.H., Chang H.H., Kuo Y.S., Lan W.H., Kok S.H. Carcinoma and dysplasia in oral leukoplakias in Taiwan: prevalence and risk factors. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 102(4):462-468. 2006
36.  Hung P.C., Chang H.H., Yang P.J., Kuo Y.S., Lan W.H., Lin C.P. Comparison of the Gow-Gates mandibular block and inferior alveolar nerve block using a standardized protocol. J Formos Med Assoc. 105(2):139-46.2006
37.  Lee J.J., Kuo M.Y., Cheng S.J., Chiang C.P., Jeng J.H., Chang H.H., Kuo Y.S., Lan W.H., Kok S.H. Higher expressions of p53 and proliferating cell nuclear antigen (PCNA) in atrophic oral lichen planus and patient with areca quid chewing. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 99:471-478. 2005
38.  Lee J.J., Jeng J.H., Wang H.M., Chang H.H., Chiang C.P., Kuo Y.S., Lan W.H., Kok S.H. Univariate and multivariate analysis of prognostic significance of betel quid chewing in squamous cell carcinoma of buccal mucosa in Taiwan. Journal of Surgical Oncology. 91: 41-47. 2005.
39.  Chang H.H., Tseng H., Hsieh M.H., Huang C.Y., Chen Y.H., Hsu C.Y., Cheng W.M., Chen M.H., Chen S.R., Yao C.C. The effects of distraction osteogenesis on mandibular growth in growing minipigs：a report on 3-D morphological changes. Plastic and Reconstructive surgery. 115: 2014-2024. 2005
40.  Cheng S.J., Lee J.J., Ting L.L., Tseng I-Yun; Chang H.H., Chen H.M., Kuo Y.S., Hahn L.J., Kok S.H. A clinical staging system and treatment guidelines for maxillary osteoradionecrosis in irradiated nasopharyngeal carcinoma patients. Int. J. Radiation Oncology Biol. Phys. 2005
41.  Hu K.Y., Lin P.Y., Wu D.W., Chang H.H., Kuo Y.S., Lan W.H. Clinical and histological changes of a free radial forearm flap transplanted into the oral cavity- a case report.. Chinese Journal of Dentistry 1(1):54-60. 2005
42.  Chang H.H., Lee J.J., Yang P.J., Hahn L.J., Kuo Y.S. Effectiveness of an educational program in reducing the incidence of wrong-site tooth extraction. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 98(3):288-294. 2004
43.  Wong W.P., Lee J.J., Chang H.H.*, Chang H.F., Lan W.H., Yang P.J. Craniofacial Differences In Patients with Angle’s Class I Malocclusion – The Comparison between childhood and adolecent. Chinese Dental Journal. pp97-104 23(2):97-104. 2004.
44.  Chang H.H., Lee J.J., Kok S.H., Yang P.J. Periodontal healing after mandibular third molar surgery – a comparison of distolingual alveolectomy and tooth division techniques. International Journal of Oral and Maxillofacial Surgery 33:32-37. 2004.
45.  Lu W.C., Kok S.H., Kuo Y.S., Lan W.H., Chang H.H.* Analysis of dental emergencies in National Taiwan University Hospital: basic patient data. Chinese Dental Journal. 22(3): 251-264. 2003.
46.  Kuo S.C., Chang H.H., Kuo Y.S., Lan W.H., Kuo S.H.* Analysis of dental emergencies in National Taiwan University Hospital: study of first and subsequent patient visits. Chinese Dental Journal. 22(3): 265-278. 2003.

47.  Lee J.J., Kok S.H., Chang H.H., Lin C.C., Yang P.J., Hahn L.J., Kuo Y.S.* Repair of oroantral communications in the third molar region by random palatal flap. International Journal of Oral and Maxillofacial Surgery. 31: 677-680. 2002

2017年9月25日 星期一

Experience of Non-grafted Sinus Lifting Combined Implant Surgery



Dr Ta-Wei CHEN
陳大為醫師

National Yang-Ming University



Sinus grafting combined implant surgery is a widely used and mature treatment, however better grafting material is still under researching. Just sinus lifting without graft is a different way to solve the bone deficiency problem, but rarely reported. In the past 13 years, we did sinus lifting without graft combined with implant placement and got good results. From this novel and precious experience, we learned more about the process of endo-sinus new bone formation; and from this biological basis, we could modify the surgical technique to get more predictable result. In the long term follow-up, the result also proved this treatment.

References


1.
Lateral trap-door window approach with maxillary sinus membrane lifting for dental implant placement in atrophied edentulous alveolar ridge.
Kao SY, Lui MT, Cheng DH, Chen TW.
J Chin Med Assoc. 2015 Feb;78(2):85-8. doi: 10.1016/j.jcma.2014.05.016. Epub 2014 Oct 3. Review.

2.
A 5-year follow-up of 80 implants in 44 patients placed immediately after the lateral trap-door window procedure to accomplish maxillary sinus elevation without bone grafting.
Lin IC, Gonzalez AM, Chang HJ, Kao SY, Chen TW.
Int J Oral Maxillofac Implants. 2011 Sep-Oct;26(5):1079-86.

3.
Implant placement immediately after the lateral approach of the trap door window procedure to create a maxillary sinus lift without bone grafting: a 2-year retrospective evaluation of 47 implants in 33 patients.
Chen TW, Chang HS, Leung KW, Lai YL, Kao SY.
J Oral Maxillofac Surg. 2007 Nov;65(11):2324-8.

無補骨之鼻竇增高術應用於植牙治療之經驗


在上顎後牙區植牙時合併鼻竇內補骨的手術,是一種廣為使用且成熟的術式, 追求更佳效果的補骨材料也一直是研究的方向.不放置補骨材料的鼻竇增高術,是另一種思考及方向,在過去13年我們施行無補骨之鼻竇增高術合併植牙的手術,得到良好的效果.尤其從這些寶貴的經驗中,我們了解鼻竇內新生骨如何生成的過程, 進而根據這個生物及生理基礎去修正手術的技巧以獲得更好的效果.在長期追蹤的結果,也顯示此種手術的良好結果.


Cheek line: From the unknown to the known

Chun Ming, CHEN
陳俊明 

Professor, dental school, college of dental medicine, Kaohsiung medical university,Taiwan
Attending staff, department of oral and maxillofacial surgery, Kaohsiung medical university hospital, Taiwan
高雄醫學大學牙醫系教授
高雄醫學大學附設醫院口腔顎面外科主治醫師


Cheek line, the face reading, is a curve-shaped soft tissue at the forefront of the cheek bone and is a crucial landmark in facial aesthetics. Cheek line is located between the nose and the cheek bone in the lateral view of the human face. In clinical observations, we found that cheek line was advanced slightly when their mandibles were set back through orthognathic operations in treatment of mandibular prognathism. Even numerous studies have investigated the changes in the soft tissues after treatment of mandibular prognathism by orthognathic surgery. However, there is no report concerning the changes of cheek line after operation. The purpose of present study was to investigate postoperative changes in the cheek lines and facial profile after mandibular setback surgery.

2017年9月24日 星期日

Dr. Chun-Feng Chen





Dr. Chun-Feng Chen is a surgical oncologist in the Kaohsiung Veteran General Hospital in Taiwan. He is also the director of Oromaxillofacial Surgery Department. Dr. Chen has conducted several exercise studies in cancer populations and has published reliable and easy reconstructive policies for oral and face defect post oral cancer surgery. Other recent work has focused on the relationship between epigenetic regulation and tumorigenesis in oral sqaumous cell carcinoma in biological levels. 

The Sternocleidomastoid Flap for Oral Cavity Reconstruction: Extended Indications and Technical Modifications

Sternocleidomastoid Flap for Oral Cavity Reconstruction: Extended Indications and Technical Modifications

Chun-Feng Chen a,b  DDS, MS, Associate Professor  
陳竣峰 主任

a Department of Oromaxillofacial Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

  b Dental Laboratory Technology, Shu Zen College of Medicine & Management, Kaohsiung, Taiwan



Abstract
Purpose: Several investigators have found that preserving the superior thyroid artery flap can considerably increase the survival rate of the sternocleidomastoid (SCM) flap. Nevertheless, they have recommended not cleaning the lymph nodes above level II for occipital artery preservation, which can leave risky metastatic lymph nodes and restrict the application of the SCM flap in patients with at least stage N1. The authors propose that preserving only the superior thyroid arteriovenous system is sufficient to ensure survival of the SCM flap and preserving the occipital artery is not necessary. They also propose preserving the cranial portion of the external jugular vein for improved venous return of the skin paddle.

Patients and Methods: This study retrospectively examined 20 patients with oral cancer (18 male, 2 female; 33 to 92 yr old; median age, 57.5 yr) who underwent SCM flap reconstruction from September 2011 to September 2014. All patients underwent surgical resection and immediate reconstruction with the SCM flap.

Results: The dimensions of the skin paddle ranged from 5x4 to 8x5 cm (length x width; mean, 6.7x4.2 cm). Arteriovenous type 1A1V of the superior thyroid arteriovenous system accounted for 30% of cases, 1A2Vaccounted for 30% of cases, 2A2Vaccounted for 25% of cases, 2A1Vaccounted for 5% of cases, 2A3V accounted for 5% of cases, and 3A2V accounted for 5% of cases. The mean number was 10.7 lymph nodes (standard deviation, 4.1 lymph nodes) per dissection above level II and 2 cases had level II lymph nodes metastasis. Only 1 case (5%) exhibited marginal loss of the skin paddle. The average operative time was 6.8 ±0.9 hours and hospitalization was 12 ± 2.2 days. Follow-up ranged from 2 to 36 months. Two patients died of metastatic disease and 2 patients developed neck recurrences.

Conclusions: Using the SCM flap with modifications is a reliable and convenient technique with wide application in the reconstruction of head and neck defects.