Oroantral fistula is an uncommon complication in oral surgery. Although smaller fistulas of less than 5 mm in diameter may close spontaneously, larger fistulas always require surgical closures. The literature review revealed various procedures for the closure of oroantral fistulas. These procedures may be subdivided into local flap, distant flap and grafting. Procedures involving local flaps are usually adequate to close minor to moderate size defects. Those procedures utilizing the buccal mucoperiosteal flap as the tissue closure include straight-advancement, rotated, sliding and transversal flap procedures; while those involving the palatal mucoperiosteum are straight advancement, rotational-advancement, hinged and island flap procedures. The combinations of various local flaps to strengthen the tissue closure are also being advocated. The advantages and the limitations of these procedures are discussed. Distant flaps and bone grafts are usually indicated in the closure of larger defects in view of their greater tissue bulks. Tongue flaps have superseded extra-oral flaps from extremities and forehead for aesthetic reasons and also in view of their similar tissue replacement. Various tongue flap procedures are described. At present, various alloplastic materials such as gold, tantalum and polymethylmethacrylate are infrequently reported in the closure of oroantral fistulas. However, in the light of successful reports over the use of biological materials, collagen and fibrin, in the closure of oroantral fistulas, there seems to be another simple alternative technique for treating oroantral fistulas.
Four patients underwent reconstruction of anterior cranial fossa of skull defects between November 1997 and January 1998. All of them had traumatic anterior cranial fossa defect and were reconstructed with lyophilised bovine cortical bone graft. There was no cerebrospinal fluid leakage, meningitis, extradural abscess or other infections. This study demonstrates that the use of bovine bone graft in the reconstruction of anterior base defects is safe.
Internal fixation with a plate in the management of non-union for shaft of long bones has been condemned but the review of the literature does not provide such unequivocal evidence. Also there are certain situations where it is either technically not feasible or contraindicated to do closed intramedullary nailing. This study was done to see the outcome of plate-fixation for the treatment of non-union of the shaft of long bones.
A review was carried out in 21 cases of bone transport in the tibia done between May 1995 and December 1997. These were done for the treatment of compound (Grade IIIB) fractures with extensive bone and soft tissue loss and in infective non-unions of the tibia using the Ilizarov technique and ring fixator. In 5 cases, 2 or 3 additional procedures were needed such as tendo achilles (TA) lengthening, bone grafting, revision of construct or revision of scar at the docking site. Average resection of infected bone was 5.2 cms in the infective non-union group and average bone and soft tissue loss was 8 cms in the compound Grade IIIB fracture group. The defect was bridged and regenerate bone occurred in all the cases except one. Union was achieved in all the cases although 10 needed bone grafting. Infection was eradicated in all the cases. Limb length discrepancy was corrected in all the cases except three. Mean duration of treatment was 12 months.
Tuberculous paraplegia in pregnancy is reported to be rare. Paraplegia due to tuberculosis has a good prognosis if surgical decompression and stabilisation are done early together with chemotherapy. Vaginal delivery is not contraindicated in pregnancy complicated by paraplegia, but is associated with problems related to the initiation and progression of labour. Performing spinal nursing on an unstable spine with a rapidly enlarging gravid uterus in the third trimester of pregnancy poses a significant challenge. We report successful simultaneous Caesarean section and surgical treatment of a paraplegic spine due to tuberculosis.
We report the results of external fixation in 29 patients treated for tibial fractures and tibial non-union using a novel multi axial external fixator (MAXX) followed prospectively until bony union. The results of treatment were classified according to the Association for the Study and Application of the Method of Ilizarov (ASAMI). Overall, 13 patients had excellent bone results; 13 had good bone results; two had fair bone results, and 1 patient had poor bone results. Regarding functional results, 21 patients had excellent results; 6 obtained good results; none had fair results, and two had poor results. Acute patients did better functionally than chronic patients. This fixator is safe and versatile, although the indications for its use are very specific.
We report a case of a 13-year-old girl with an osteosarcoma of the right humerus, which had been diagnosed as an aneurysmal bone cyst at our institution. She underwent curettage and bone grafting of the lesion, which resulted in implantation metastasis of the tumour to the ilium. She died 15 months after presentation owing to pulmonary metastases. This report highlights the possibility of metastasis occurring by direct implantation to a graft donor site. We strongly recommend that a biopsy be performed in cases of presumed benign lesions before proceeding with the definitive surgery.
Matched MeSH terms: Bone Transplantation/adverse effects*
Thirteen patients had skeletal reconstruction using vascularised fibula graft following resection of the diseased bone. Eleven patients had reconstruction of the lower limbs and two patients of the upper limbs. Clinical and radiographical evidence union were achieved with the average time of 32 weeks (earliest eight weeks). Six out of 11 patients (54%) in lower limb reconstruction started weight bearing at the average of 27 weeks. Bony union in this study is comparable with other studies using vascularised fibula graft.
Matched MeSH terms: Bone Transplantation/mortality; Bone Transplantation/rehabilitation*
Tricalcium phosphate/hydroxyapatite (TCP/HA), hydroxyapatite (HA), chitosan and calcium sulphate (CaSO4) were studied and evaluated for possible bone tissue engineered construct acting as good support for osteogenic cells to proliferate, differentiate, and eventually spread and integrate into the scaffold. Surface morphology visualized by SEM showed that scaffold materials with additional fibrin had more cell densities attached than those without, depicting that the presence of fibrin and collagen fibers were truly a favourite choice of cells to attach. In comparison of various biomaterials used incorporated with fibrin, TCP/HA had the most cluster of cells attached.
In the present study, natural coral of porites species was used as scaffold combined with in vitro expanded bone marrow stem cell derived osteoblasts (BMSC-DO), to develop a tissue-engineered bone graft in a rat model. Coral was molded into the shape of rat mandible seeded with 5x10(6) /ml BMSC-DO subsequently implanted subcutaneously in the back of 5 week Sprague dawely rats for 3 months. Coral alone was implanted as a control. The implants were harvest and processed for gross inspection and histological observations. The results showed that newly bone grafts were successfully formed coral seeded with cells group showed smooth highly vascularized like bone tissue. Histological sections revealed mature bone formation and lots of blood vessel, the bone formation occurred in the manner resemble intramembraneous bone formation. This study demonstrates that coral can be use as a suitable scaffold material for delivering bone marrow mesenchymal stem cells in tissue engineering.
The strategy used to generate tissue-engineered bone construct, in view of future clinical application is presented here. Osteoprogenitor cells from periosteum of consenting scoliosis patients were isolated. Growth factors viz TGF-B2, bFGF and IGF-1 were used in concert to increase cell proliferation during in vitro cell expansion. Porous tricalcium phosphate (TCP)-hydroxyapatite (HA) scaffold was used as the scaffold to form 3D bone construct. We found that the addition of growth factors, greatly increased cell growth by 2 to 7 fold. TCP/HA proved to be the ideal scaffold for cell attachment and proliferation. Hence, this model will be further carried out on animal trial.
Bone marrow stem cells (BMSC), known for its multipotency to differentiate into various mesenchymal cells such as chodrocyte, osteoblasts, adipocytes, etc, have been actively applied in tissue engineering. BMSC have been successfully isolated from bone marrow aspirate and bone marrow scraping from patients of various ages (13-56 years) with as little as 2ml to 5ml aspirate. BMSC isolated from our laboratory showed the presence of a heterogenous population that showed varying prevalence of surface antigens and the presence of telomerase activity albeit weak. Upon osteogenic induction, alkaline phosphatase activity and mineralization activity were observed.
Patient own fibrin may act as the safest, cheapest and immediate available biodegradable scaffold material in clinical 1 tissue engineering. This study investigated the feasibility of using patient own fibrin isolated from whole blood to construct a new human cartilage, skin and bone. Constructed in vitro tissues were implanted on the dorsal part of the nude mice for in vivo maturation. After 8 weeks of implantation, the engineered tissues were removed for histological analysis. Our results demonstrated autologous fibrin has great potential as clinical scaffold material to construct various human tissues.