Microanatomic analysis of the trigeminal nerve and potential nerve graft donor sites.

A histologic study was undertaken to define the microanatomic characteristics of two commonly injured peripheral trigeminal nerve branches (lingual and mandibular nerves) and the two nerves most frequently procured for use in their interpositional graft repair (sural and greater auricular nerves). Nerves, obtained from fresh human cadavers, were evaluated for total fascicular area, fascicle number, axon number, axon size, and axon density. The peripheral branches of the trigeminal nerve (third division) were morphometrically similar, with only a slight decrease in axon density in the lingual nerve. Comparisons between the donor nerves, however, showed numerous discrepancies at the axonal level. While the fascicular area of the sural nerve was only slightly smaller, axon numbers and densities were only one-half that of the trigeminal nerves. Although the greater auricular nerve was appreciably smaller in overall size, a much better correlation existed with the trigeminal nerve in axonal qualities. These microanatomic findings raise questions about the potential capability of these graft choices to optimally restore axonal connections between nerve ends in trigeminal nerve repair.

Enhancement of repair in experimental calvarial bone defects using calcium sulfate and dextran beads.

Granular medical-grade calcium sulfate hemihydrate (MGCSH) and negatively charged dextran beads (DB) were evaluated both separately and in combination in cranial defects. Thirty-six rats received bilateral parietal inlay reconstructions using MGCSH, MGCSH plus DB, or DB alone or the defects were left unfilled. Postoperative evaluation at 45, 90, and 135 days was done by visual inspection, caliper measurements of defect thickness, and histologic examination. The best fibro-osseous repair of the defects occurred with the use of MGCSH in combination with DB. Repair tissue, which was confluent with the adjacent cranium, was noted to have good thickness, and a high bone content. By contrast, defects repaired with either DB or MGCSH alone had poorer quality repair tissue, with concavities, voids, bead migration, decreased thickness, and minimal bony replacement/ingrowth. Unfilled control defects showed only a thin, friable, translucent connective tissue layer of repair. No method produced complete bony closure.

Negatively charged resins stimulate bone formation in subperiosteal sites in rats. The effect of age.

The osteogenic response to subperiosteal injection of negatively charged ion exchange resins was compared in the tibiae of one-month and 16- to 22-month-old rats. The resins were administered either in the form of beads (CM Sephadex) or as particles (CM cellulose, carboxymethylcellulose), and the animals were killed at two weeks and at one month after injection. Histologically, the resins did not produce an inflammatory response. Periosteal bone formation was observed wherever resin was in contact with bone, and in the resin bed the connective tissues that invested the charged materials ossified within the first month. Marrow spaces commonly formed where periosteal growth was most rapid. The osteogenic effect was independent of resin conformation, and it was more pronounced in the younger rats.

Efficacy of nerve growth factor in regeneration of the mandibular nerve: a preliminary report.

An experimental study evaluating the potential utility of nerve growth factor (NGF) on sensory nerve regeneration was conducted in a rabbit mandibular nerve model. In 10 animals, bilateral 7-mm nerve gaps were created and repaired with the placement of 10-mm Silastic (American Scientific Products, McGaw Park, IL) conduits into which NGF (left side) and a control solution (cytochrome C, right side) was instilled. After 90 days, the nerve repairs were removed and the two sides compared by clinical appearance, and histologic and electrophysiologic assessment. The conduits instilled with control solution failed to result in nerve regeneration in any of the animals. The conduits with NGF solution, however, consistently displayed neural connections between the proximal and distal ends with the presence of slowed, but recordable, conduction velocities. The axonal numbers in the NGF repairs were significantly less than those of the normal nerve, but when adjusted for fascicular size, the axonal densities were comparable. In addition, osteoid tissue was observed around many of the NGF-induced nerve regenerates, but not on the control solution side, suggesting a possible influence of this protein on bone formation.

Effects of nerve growth factor on craniofacial onlay bone graft survival: preliminary findings.

A study was undertaken to evaluate the effects of nerve growth factor (NGF), which had previously demonstrated bone formation around mandibular nerve regenerates, on resorption of onlay bone grafts to the rabbit skull. Iliac grafts were onlayed on the parietal bone bilaterally and immobilized with wire ligatures in 15 animals. NGF and a control solution were introduced into the grafts through subcutaneous osmotic pumps. After 60 days, graft survival was compared by weights, histology, and fluorochrome labels. NGF-treated grafts were characterized by an average of 88.4% weight retention, preservation of the outer cortical plate with firm fixation to the underlying calvarium, and fluorescent labels localized to the inner cortex. Conversely, control grafts had an average weight retention of 42.8% (p < 0.01), nearly complete outer cortical plate loss with increased mobility of the residual inner cortex, and a lack of fluorescence in any part of the grafts. Despite the incongruous name, NGF exhibited a beneficial effect on onlay bone graft volume maintenance in this study. Although the mechanism and the long-term effects are unknown, inhibition of graft resorption rather than enhancement of bone formation is suggested.

Autologous facial fat transplantation: improved graft maintenance by microbead bioactivation.

An alternative approach to the management of free fat transplantation resorption was evaluated in a rat facial model. Fat grafts obtained from the inguinal region were transferred to subcutaneous lateral facial sites in 20 animals. The grafts were mixed with either basic fibroblast growth factor (bFGF) alone or dextran beads that had been pretreated with bFGF. The grafts were then compared by weight and histology at 1 and 6 months postoperatively. Although graft weights were nearly comparable at 1 month, substantial differences were seen at 6 months, with the bead-containing grafts exhibiting near complete weight maintenance and better overall graft form. Histologically, the bead-containing grafts had extensive intercellular collagen formation and a heterogeneity of adipocyte cell sizes, particularly after 1 month. These findings suggest that the addition of cell-specific bioactive peptides that affect either the preadipocyte cell line and/or the fibroblastic components of the recipient site improve postoperative fat graft weight maintenance. Delivery of the biochemical agent appears to require a carrier system to exert its effects.