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1.
Int J Psychiatry Med ; : 912174231225801, 2023 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-38156371

RESUMO

OBJECTIVE: The aim of this study was to evaluate the impact of social support and religiosity/spirituality (R/S) on the recovery from an acute cardiac event or cardiac surgery during cardiac rehabilitation (CR). METHODS: The study has a prospective design. A convenience sample of 159 patients participating in a CR program were enrolled. Religiosity/spirituality, social support, anxiety, depression, health related quality of life (QoL) and exercise capacity (6-min walk test, cycle ergometer test) were assessed. RESULTS: Social support was significantly associated with less anxiety (P < .01), less depression (P < .01), and better QoL (P < .05) on admission. After adjustment for age, gender, education level, and morbidity, social support remained significantly associated with less depression (P < .001). Religiosity/spirituality was significantly associated with less depression (P < .05), better QoL (P < .05), and better exercise capacity (P < .05) at admission. After adjustment for covariates, however, significance was lost. There were no significant associations of social support or R/S with the course of CR measured by change in QoL or exercise capacity. CONCLUSION: Social support may be a protective factor against depression in the recovery from cardiac events or surgery. Neither social support nor R/S had a significant impact on the course of the 3-week CR program.

2.
Oral Dis ; 28(3): 568-576, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33583133

RESUMO

BACKGROUND AND PURPOSE: Rhino-orbito-cerebral mucormycosis (ROCM) is a rare and potentially fatal invasive fungal infection which usually occurs in diabetic and other immunocompromised patients. This infection is associated with high morbidity and mortality rates. Prompt diagnosis and rapid aggressive surgical debridement and antimycotic therapy are essential for the patient's survival. Herein, we reviewed the localization and treatment strategies in patients with ROCM and diabetes as an underlying condition. Furthermore, we report one case of ROCM in our department. MATERIALS AND METHODS: From 117 identified studies published in PubMed, 14 publications-containing data from 54 patients-were included. All patients were diagnosed clinically and by histopathological and/or bacteriological analysis for ROCM caused by the order Mucorales. CONCLUSION: Uncontrolled diabetes mellitus is one of the main risk factors for ROCM. A successful management of ROCM requires an early diagnosis, a prompt systemic antifungal therapy, and a rapid aggressive surgical debridement including exploration of the pterygopalatine fossa. An orbital exenteration may be necessary.


Assuntos
Diabetes Mellitus , Mucormicose , Doenças Orbitárias , Antifúngicos/uso terapêutico , Diabetes Mellitus/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Mucormicose/complicações , Mucormicose/diagnóstico , Mucormicose/terapia , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/microbiologia , Doenças Orbitárias/terapia
3.
J Craniofac Surg ; 27(2): 433-40, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26825741

RESUMO

OBJECTIVE: To review the outcome and cosmetic results of patients undergoing extended subfrontal and fronto-orbito-zygomatic craniotomy for resection of skull base meningiomas. METHODS: All surgeries were performed in cooperation with an oral and maxillofacial surgeon between 2006 and 2012. Clinical presentation, surgical techniques and complications, cosmetic, clinical, and radiologic outcomes are presented. RESULTS: This study included 25 consecutive patients with 26 operations. Total and subtotal tumor removal was obtained in 19 (73.1%) and 7 (26.9%) patients, respectively. Permanent postoperative complications were seen in 5 (19.2%) patients. Eight of 10 patients with preoperative visual impairment showed recovery at 6 months follow-up. Anosmia was improved in 50% and no worsening was seen in any case of hyposmia. All patients showed improved or complete correction of exophthalmos, cognitive deficits, and epilepsy. One patient (3.8%) developed a postoperative ptosis. No mortality was documented. All patients reported a favorable cosmetic satisfactory score over 6 (8.67 ±â€Š1.6). Tumor recurrence rate was 7.7% (n = 2). CONCLUSIONS: The extended subfrontal and fronto-orbito-zygomatic approach, used for resection of meningiomas located in the orbita and the skull base can provide better visibility of the tumor. In addition, these approaches lead to highly satisfying cosmetic and clinical results.


Assuntos
Craniotomia/métodos , Meningioma/cirurgia , Neoplasias da Base do Crânio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estética , Feminino , Seguimentos , Osso Frontal/cirurgia , Humanos , Masculino , Neoplasias Meníngeas/cirurgia , Meningioma/patologia , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Procedimentos Neurocirúrgicos/métodos , Órbita/cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias , Estudos Retrospectivos , Base do Crânio/cirurgia , Resultado do Tratamento , Zigoma/cirurgia
4.
J Craniomaxillofac Surg ; 49(7): 598-612, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34020871

RESUMO

OBJECTIVE: This retrospective study evaluates the occurrence and frequency of different fracture patterns in a series of computed tomography (CT) scans in terms of the AOCMF Trauma Classification (TC) orbit module and correlates the assigned defects with measurements of the fracture area in order to get an approximate guideline for fracture size predictions on the basis of the classification. MATERIAL AND METHODS: CT scans of patients with orbital floor fractures were evaluated using the AOCMFTC to determine the topographical subregions. The coding consisted of: W = orbital wall, 1 = anterior orbit, 2 = midorbit, i = inferior, m = medial. The 3-dimensional surface area size of the fractures was quantified by the "defect body" method (Brainlab, Munich, Germany). The fracture area size and its confidence and prediction interval within each topographical subregion was estimated by regression analysis. RESULTS: A total of 137 CT scans exhibited 145 orbital floor fractures, which were combined with 34 medial orbital wall fractures in 31 patients. The floor fractures - W1(i)2(i) (n = 86) and W1(i) (n = 19) were the most frequent patterns. Combined floor and medial wall fractures most frequently corresponded to the pattern W1 (im)2 (im) (n = 15) ahead of W1 (im) 2(i) (n = 10). The surface area size ranged from 0.11 cm2 to 6.09 cm2 for orbital floor and from 0.29 cm2 to 5.43 cm2 for medial wall fractures. The prediction values of the mean fracture area size within the subregions were computed as follows: W1(i) = 2.25 cm2, W2(i) = 1.64 cm2, W1(i)2(i) = 3.10 cm2, W1(m) = 1.36 cm2, W2(m) = 1.65 cm2, W1(m)2(m) = 2.98 cm2, W1 (im) = 3.35 cm2, W1 (im) 2(i) = 4.63 cm2, W1 (im)2(m) = 4.06 cm2 and W1 (im)2 (im) = 7.16 cm2. CONCLUSION: The AOCMFTC orbital module offers a suitable framework for topographical allocation of fracture patterns inside the infero-medial orbital cavity. The involvement of the subregions is of predictive value providing estimations of the mean 3-D fracture area size.


Assuntos
Órbita , Fraturas Orbitárias , Alemanha , Humanos , Órbita/diagnóstico por imagem , Fraturas Orbitárias/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
5.
Dent Traumatol ; 26(1): 112-4, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19788427

RESUMO

We present a case where a patient sustained a tympanic plate fracture of the right side while chewing a sandwich. Intense pain with temporomandibular joint (TMJ) symptoms such as restrained painful mouth opening and functional pain in full occlusion followed the incident and the fracture was diagnosed after ocular and CT-examination of the right external auditory canal. Non-ruptured soft tissue could be seen protruding into the external auditory canal and the size of the mass changed during movement of the TMJ. Treatment was not needed to resolve the situation and at 3-year follow-up the patient has no clinical symptoms.


Assuntos
Dor Facial/etiologia , Fraturas Cranianas/complicações , Osso Temporal/lesões , Articulação Temporomandibular/lesões , Adulto , Orelha Externa/lesões , Feminino , Humanos , Mastigação , Fraturas Cranianas/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem , Articulação Temporomandibular/diagnóstico por imagem , Tomografia Computadorizada por Raios X
6.
J Dent Child (Chic) ; 87(3): 166-170, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-33349301

RESUMO

Neuroblastoma is a malignant embryonal tumor derived from the neural crest cells of the sympathetic nervous system. Curative therapy is challenging, especially because early-stage diagnosis in toddlers is difficult. Successful treatment of high-risk neuroblastoma is only achieved in approximately half of the cases and requires an immediate interdisciplinary approach. We present a 34-month-old toddler with swelling of the left side of the face of three days duration and a mandibular mass of unknown duration, which was diagnosed as a metastasis of a neuroblastoma. He also had metastases in the kidney, long bones and skull. Despite the poor prognosis in cases of disseminated skeletal involvement and N-myc amplification, the young patient remained free of recurrence during a follow-up period of 36 months after multidisciplinary treatment. The purpose of this case report is to increase awareness of the clinical features of neuroblastoma among pediatric dentists to support early-stage diagnosis and highlight interdisciplinary management.


Assuntos
Neuroblastoma , Pré-Escolar , Humanos , Lactente , Masculino , Neuroblastoma/terapia , Prognóstico
7.
J Plast Reconstr Aesthet Surg ; 73(1): 98-102, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31711860

RESUMO

BACKGROUND: Precise, expensive individual saw guides are used with increasing frequency for the reconstruction of mandibular defects with fibular grafts. In this report, an alternative is presented - the Multiuse Cutting Jig (MUC-Jig, proprietary development). It is reusable, suitable for all patients, requires simple planning based on conventional CT imaging, and is more economical. METHODS: To investigate its precision, we conducted a nonblinded experimental study, with ten participating craniomaxillofacial surgeons. Osteotomies of four different fibula segments were carried out at the same angulation, with groups defined according to the proximal and distal fixed angulation: 45°, 30°, 15°, or 0°. The sagittal cut was performed proximally, with the coronal cut performed distally. The resulting 40 segments (n = 40) were analyzed with their Tx length (primary endpoint) and osteotomy angles, and compared to the original planning. RESULTS: The mean (SD) relative deviation of all grafts from the original planning was -0.08 mm (1.12) in length and -0.71° (3.15) for the angle. Only 45° (-2.04 ±â€¯3.71°) and 30° (-1.07 ±â€¯2.52°) cuts differed significantly (p < 0.05) from smaller angle grafts. The mean (SD) absolute deviation was 0.81 mm (0.27) in length and 2.13° (0.93) in graft angles. For individual transplants, 45° cuts (1.28 ±â€¯1.03 mm) differed significantly (p < 0.005) from others. We observed no differences in relative length or absolute angle deviation. CONCLUSIONS: The MUC-Jig is precise and cost-effective for osteotomies with medium angles and smooth reconstructions of template-guided procedures.


Assuntos
Fíbula/transplante , Retalhos de Tecido Biológico , Reconstrução Mandibular/instrumentação , Osteotomia/instrumentação , Transplante Ósseo/instrumentação , Angiografia por Tomografia Computadorizada , Desenho de Equipamento , Humanos , Invenções , Mandíbula/cirurgia , Modelos Anatômicos , Impressão Tridimensional , Instrumentos Cirúrgicos
8.
J Clin Med ; 9(12)2020 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-33419329

RESUMO

Individual cutting guides for the reconstruction of lower jaw defects with fibular grafts are often used. However, the application of these osteotomy tools is costly and time intensive. The aim of this study was to compare the precision of osteotomies using a 3D-printed guide with those using a universal, reusable, and more cost-efficient Multi-Use Cutting Jig (MUC-Jig). In this non-blinded experimental study, 10 cranio-maxillofacial surgeons performed four graft removals each in a randomized order using the same osteotomy angle, both proximally (sagittal cut) and distally (coronal cut), of a graft (45°, 30°, 15°, or 0°), first with the MUC-Jig then with the 3D-printed cutting guide. The 40 fibula transplants (Tx) of each method (n = 80) were then analyzed concerning their Tx length and osteotomy angles and compared to the original planning data. Furthermore, the surgeons' subjective perception and the duration of the two procedures were analyzed. The mean relative length and mean relative angle deviation between the MUC-Jig (-0.08 ± 1.12 mm; -0.69° ± 3.15°) and the template (0.22 ± 0.90 mm; 0.36° ± 2.56°) group differed significantly (p = 0.002; p = < 0.001), but the absolute deviations did not (p = 0.206; p = 0.980). Consequently, clinically comparable osteotomy results can be achieved with both methods, but from an economic point of view the MUC-Jig is a more cost-efficient solution.

9.
Swiss Dent J ; 129(4): 287-292, 2019 Apr 08.
Artigo em Alemão | MEDLINE | ID: mdl-30932398

RESUMO

Bruxism and myoarthrophathy lead to a complex set of burdens that can involve both medical and psychological aspects. Muscular tension due to stress affects these burdens and leads to chronic pain. Using a stress model, it was explained how the individual processing of stress leads to varying negative effects on oral health and jaw function. Through a short survey, it is possible for the dentist to assess the extent of the chronic pain and the associated psychosocial burdens, and, when necessary, encourage the patient to undertake psychological guidance. By learning relaxation techniques and pain coping mechanisms, the pain can be reduced. In order to achieve a long lasting successful treatment, one must consider both medical and psychosomatic aspects.


Assuntos
Bruxismo , Artropatias , Bruxismo/complicações , Humanos , Artropatias/complicações , Saúde Bucal , Inquéritos e Questionários
10.
Ann Med Surg (Lond) ; 33: 36-39, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30167301

RESUMO

INTRODUCTION: Orocutaneous fistulae of dental origin are uncommon but well documented in the literature. This condition is often misdiagnosed because of the multiplicity of manifestations and the atypically presentation of the condition. Dental symptoms are rare. This makes diagnosis and treatment a challenging process. PRESENTATION OF A CASE: A 67-year-old patient presented in the emergency room with an abscess in the parotid area. After incision and drainage the patient developed a non-healing fistula in the region of the parotid. Multiple treatment attempts and several investigations did not solve the problem. Finally, a panoramic x-ray showed a hidden, infected and displaced tooth in the right mandibular angle. After surgical extraction of the tooth and fistula excision, healing was uneventful and there was no recurrence. DISCUSSION: Given the diagnostic challenge, the real origin of the condition is frequently only discovered after several unnecessary interventions that may have harmed the patient. The key to early diagnosis is dental examination and dental radiographs. The goal of treatment is the elimination of the infection by surgical extraction of the tooth or non-surgical endodontic therapy. CONCLUSION: Early diagnosis and rapid treatment minimize patient discomfort and reduce the probability of further complications. The differential diagnosis of sinus tract of dental origin should be considered in any case of unclarified non-healing skin lesion in the head and neck area, especially if initial treatments have failed. An early interdisciplinary approach is essential.

11.
Biomaterials ; 27(2): 202-7, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16026823

RESUMO

Biodegradable polymers have become useful auxiliary materials for the functional and structural restoration of bone deficiencies. Commercial implants from poly(L/DL-lactide) 70:30 are used clinically for fracture fixation in regions of low load. Implants manufactured from poly(L/DL-lactide) 80:20 are currently being investigated experimentally. The higher degree of crystallinity results in a higher chemical strength and loading capacity which promises advantages for long-term implantation. In this study implants from these two copolymers were applied to promote bone regeneration of bilateral, full thickness, circular cranial defects in 16 adult New Zealand white rabbits. The defects were covered with melt extruded and laser cut polylactide burr hole covers epicranially and endocranially in direct contact to the dura. The defect spaces were kept open with a spacer which created a hollow chamber. Both materials were implanted in each animal. Bone seeking fluorochromes were used to assess the pattern of bone growth. After eight weeks bone regeneration in the defects was assessed radiologically, histologically and by fluorescence microscopy. During the eight weeks observation period the application of a hollow chamber design resulted in almost complete cranial defect healing, whereby the copolymer composition had no effect on the amount or the morphology of the regenerate. The dura mater showed no adverse tissue reactions during these early stages of implantation. Eight weeks is only a short period in the lifetime of the tested polymers and complete bone regeneration can only be expected after complete polymer degradation. Long-term studies or accelerated degradation studies are required to confirm the expected advantages of poly(L/DL-lactide) 80:20.


Assuntos
Materiais Biocompatíveis/química , Regeneração Óssea/fisiologia , Regeneração Tecidual Guiada , Poliésteres/química , Crânio/fisiologia , Implantes Absorvíveis , Animais , Materiais Biocompatíveis/metabolismo , Substitutos Ósseos/química , Substitutos Ósseos/metabolismo , Feminino , Poliésteres/metabolismo , Coelhos , Crânio/patologia
12.
Int J Periodontics Restorative Dent ; 26(5): 453-7, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17073355

RESUMO

The zygomaticomaxillary region offers a large amount of cortical bone that can be obtained simply and safely using the precise and selective cutting properties of a piezosurgical device. A block from this area fits nicely into anterior or premolar maxillary recipient sites and is thus the ideal choice, as no secondary surgical field is needed. As in conventional sinus bone graft procedures, the complication rate is minimal and after a 5-month healing period, the augmented region can be used for stable and esthetic oral implant placement.


Assuntos
Transplante Ósseo/métodos , Eletrocirurgia/métodos , Procedimentos Cirúrgicos Pré-Protéticos Bucais/métodos , Coleta de Tecidos e Órgãos/métodos , Zigoma/cirurgia , Implantação Dentária Endóssea , Humanos , Masculino , Seio Maxilar/cirurgia , Pessoa de Meia-Idade , Osteotomia/métodos
13.
J Am Dent Assoc ; 136(7): 921-5, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16060473

RESUMO

BACKGROUND: The orbit is prone to being affected by an odontogenous infection, owing to its anatomical proximity to the maxillary sinus. A possible reason for an ophthalmic manifestation of a dental abscess is extraction of an acutely inflamed tooth. CASE DESCRIPTION: The authors describe the treatment of a man who had painful swelling and redness in the area of his right eye after having a maxillary molar extracted a few days previous. A general dentist referred the patient to the clinic after he began to experience a progressive deterioration of vision of his right eye. Emergency surgical intervention prevented impending loss of vision, and subsequent healing was uneventful. CLINICAL IMPLICATIONS: To avoid serious complications, clinicians should not perform a tooth extraction when the patient is in the acute stage of a maxillary sinus infection. Appropriate diagnostic imaging and profound evaluation of the clinical state play major roles in managing the treatment of patients with inflammatory processes that involve the oral and paraoral regions.


Assuntos
Abscesso/microbiologia , Infecção Focal Dentária/microbiologia , Doenças Orbitárias/microbiologia , Adulto , Empiema/microbiologia , Seio Etmoidal/microbiologia , Humanos , Masculino , Seio Maxilar/microbiologia , Dente Molar/cirurgia , Doenças dos Seios Paranasais/microbiologia , Extração Dentária/efeitos adversos
14.
J Plast Surg Hand Surg ; 49(2): 95-101, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24909821

RESUMO

The free fibula osteoseptocutaneous flap is the standard for reconstruction of extensive mandibular defects. The procedure must be precise to achieve the required functional and aesthetic results. The aim of the present study was to calculate retrospectively the exact differences in surgical outcome based on preoperative and postoperative Computed Tomography data sets. Ten patients with unilateral reconstructions of the mandible with a fibula based on conventional planning were analyzed quantitatively, applying mirroring techniques with direct comparison of the theoretically optimum with the actual reconstruction. The results showed that there is a significant discrepancy between what is actually achieved and the theoretical optimum. The result of the present retrospective analysis shows that there is room for further improvement of the outcome in complex mandible reconstruction cases.


Assuntos
Transplante Ósseo/métodos , Carcinoma de Células Escamosas/cirurgia , Fíbula/transplante , Mandíbula/cirurgia , Neoplasias Mandibulares/cirurgia , Cirurgia Assistida por Computador , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica , Estudos Retrospectivos , Retalhos Cirúrgicos/irrigação sanguínea , Tomografia Computadorizada por Raios X
16.
J Craniomaxillofac Surg ; 37(6): 305-11, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19264499

RESUMO

PURPOSE: A comprehensive classification based on high resolution computed tomography (CT) of the whole craniofacial region was correlated with clinical findings of combined skull base and maxillofacial fractures. MATERIAL AND METHODS: In a study of two clinical centres, 70 patients with such injuries were admitted at the Universities of Basel (n=29) and Uppsala (n=41). Clinical signs (rhinorrhoea, periorbital haematoma and pneumencephalus) and surgical versus conservative treatment were correlated with a cranio-maxillofacial injury severity score (CMF-ISS) calculated from the classification system. Fracture classifications were decided in consensus on the basis of CT and semiautomatic classification software. The classification system defined 3 fracture types (A, B, C), 3 groups (A1, A2, A3), and 3 subgroups (A1.1, A1.2, A1.3) with increasing severity from A1.1 (lowest) to C3.3 (highest). RESULTS: Of 70 patients, 43 were operated upon and 27 conservatively treated. The operated patients had significantly higher severity scores than non-operated. Patients with or without periorbital haematoma do not differ significantly in the severity score. The severity of the CMF-ISS score was significantly associated (two sample T-test P<0.01) with the occurrence of pneumencephalus, rhinorrhoea and treatment approach. CONCLUSION: Based on our present results, this system seems to be clinical useful for operative decisions and interventions.


Assuntos
Fixação de Fratura/métodos , Traumatismos Maxilofaciais/classificação , Base do Crânio/lesões , Fraturas Cranianas/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Rinorreia de Líquido Cefalorraquidiano/patologia , Criança , Pré-Escolar , Feminino , Hematoma/patologia , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Traumatismos Maxilofaciais/diagnóstico por imagem , Traumatismos Maxilofaciais/cirurgia , Pessoa de Meia-Idade , Doenças Orbitárias/patologia , Pneumocefalia/patologia , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Base do Crânio/cirurgia , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/cirurgia , Software , Tomografia Computadorizada por Raios X , Adulto Jovem
18.
Pediatr Neurosurg ; 41(6): 285-91, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16293947

RESUMO

Restoring the bone integrity to injured calvariae remains a challenge to surgeons. In this study, the dural biocompatibility of biodegradable poly-L/DL-lactide 80/20 and 70/30 defect covers, designed for guided bone regeneration, was assessed. In each of the 16 test rabbits, bilateral (8.3 mm) cranial defects were created. The different covers were applied to one defect each in every rabbit and consisted of three parts: an epicranial cover, a spacer, and a dural cover. All defects had closed after 8 weeks due to new bone formation. A few giant cells were found at the cover-to-dura interface in equal numbers for both covers. Dural bone formation was present in 15 of 16 rabbits and progressed unhindered by the defect cover or its early degradation products.


Assuntos
Implantes Absorvíveis , Regeneração Óssea , Dura-Máter/cirurgia , Osso Parietal/cirurgia , Poliésteres/farmacologia , Animais , Tecido Conjuntivo/metabolismo , Feminino , Células Gigantes de Corpo Estranho/metabolismo , Microscopia de Fluorescência , Poliésteres/química , Coelhos
19.
Plast Reconstr Surg ; 116(1): 194-9, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15988267

RESUMO

BACKGROUND: Cranial defects exceeding a certain size do not heal spontaneously and require surgical treatment. The prevention of uncontrolled soft-tissue ingrowth is crucial in the bony healing of such defects. METHODS: Bone regeneration of full-thickness cranial defects was assessed in 16 adult New Zealand White rabbits. A single epicranially placed cover was compared with a hollow chamber with an additional barrier on the dural side. After 8 weeks, bone regeneration in the defects was assessed radiologically, histologically, and by fluorescence microscopy. RESULTS: The hollow chamber design resulted in almost complete cranial defect healing. In contrast, five out of 16 defects covered with a single epicranial burr-hole cover showed hardly any visible bone. Inside the reserved space, there was twice as much bone coverage as compared with burr-hole covers only. CONCLUSIONS: Providing a reserved space for bone regeneration reduces the statistical spread significantly and thus makes the clinical outcome more predictable. Use of a hollow chamber can serve as a useful tool to assess the effect of bone-stimulating factors such as growth factors and bone substitutes. Hollow resorbable implants may offer a new approach in bone regeneration by reducing the need for bone autografting and the associated donor-site morbidity.


Assuntos
Regeneração Óssea , Osso Parietal/cirurgia , Animais , Feminino , Osso Parietal/fisiologia , Poliésteres , Próteses e Implantes , Coelhos
20.
J Biomed Mater Res ; 61(1): 131-7, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12001255

RESUMO

The reconstruction of bone defects is a significant problem in cranio-maxillofacial surgery. In an effort to avoid the known disadvantages of autogenous bone grafting, alternatives have been investigated. Bone substitute materials, degradable or nondegradable, aim at facilitating bone regeneration, while they take over load-bearing functions for a period of time. In this study, the healing of cranial defects in rabbits was assessed using polylactide guiding covers with and without perforations. Bilateral circular cranial defects were produced in 16 New Zealand white rabbits. The defects were covered with extruded and laser cut polylactide burr hole covers, each animal receiving a perforated burr hole cover on one side and a nonperforated one on the contralateral side. Bone seeking fluorochromes were administered at regular intervals. After an observation period of 8 weeks the amount of bone regeneration in the area of the defects was quantified from contact radiographs, and the dynamics of bone formation were assessed by fluorescence microscopy. Stained sections were used to analyze morphologic differences. No signs of adverse tissue reactions or osteolysis were observed. A bone-guiding function was observed for both covers with or without perforations. Intracranial tissue herniation into the defect hindered the regeneration process. Wide intraindividual and interindividual variation became apparent and average defect filling was only 40% within the 8-week observation period. In this model the perforated covers offered no advantage over nonperforated covers. It can be concluded from this study, that the use of external burr hole covers alone does not guarantee a full thickness regeneration of the cranial defect, but it provides a guiding function for promotion of structured bone regeneration.


Assuntos
Implantes Absorvíveis , Regeneração Óssea/fisiologia , Substitutos Ósseos , Crânio , Absorção , Animais , Feminino , Microscopia de Fluorescência , Poliésteres/química , Coelhos , Radiografia , Crânio/diagnóstico por imagem , Crânio/patologia , Crânio/cirurgia
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