Periosteal Graft Myringoplasty: Our Experience

Abstract Introduction Different types of autologous graft materials are used for myringoplasty, with the temporalis fascia and cartilage being the most frequently used tissues. Periosteal tissue has been used for a long time in our department, and many advantages support its use in myringoplasty. To the best of our knowledge, this issue is scarcely discussed in the previously published literature. Objective To present our experience with periosteal graft myringoplasty, describing the technique and the anatomical and functional outcomes. Methods A prospective clinical study involving 88 patients (72 females and 16 males) with a mean age 26.9 years. The patients underwent myringoplasty using the mastoid cortex periosteum; they were all operated using the postauricular approach, and the graft was applied using the underlay technique. The patients performed pre- and postoperative pure tone audiometry for tested frequencies (0.5 kHz, 1 kHz, 2 kHz, and 4 kHz). All patients were followed-up for at least 12 months after the operation. Results The anatomical success rate among all patients was of 93%, which is comparable to the rate of success in procedures using other usual grafting materials. In addition, there was a highly significant postoperative improvement in pure tone audiometry results as compared with the preoperative ones (the main hearing gain was of ∼ 11 dB; p< 0.001). Conclusion The periosteal graft is easily harvested, easy to apply, with excellent anatomical and functional success.

Galea and periosteum flap filled with bone fragments in rabbits

PURPOSE: To study the bone viability of a vascularized galea and periosteum flap filled with bone fragments, as a substitute of the bone graft in facial reconstructive surgery. METHODS: Forty rabbits were studied, and divided in two groups. One had a simple galea and periosteum flap done and the other had the same flap done and filled with bone fragments of the calvaria. The bone formation was evaluated by radiographies, macroscopic and microscopic analysis. RESULTS: The bone neoformation in both groups with differences in bone morphology and structure especially at histological analysis. CONCLUSION: This study demonstrated osseous formation in both groups of galea and periosteum flaps, with and without bone fragments.

Use of periosteal membrane as a barrier membrane for the treatment of buccal Grade II furcation defects in lower molars: A novel technique.

Objective : To use the periosteum as a barrier in treatment of buccal Grade II furcation defects of lower molars. Materials and Methods : This technique was performed on 12 patients with bilateral buccal Grade II furcation defects of lower molars. On a random basis, one furcation defect of each pair was selected for the control group and other for the experimental group. Debridement was done in the defect area in both groups. In the control group, after debridement, mucoperiosteal flap was sutured back. In the experimental group, after reflection of the mucoperiosteal flap, a portion of the periosteum along with a layer of connective tissue (periosteal membrane) was incised and mobilized in the defect area for defect coverage as a barrier, and then the periosteal membrane and mucoperiosteal flap were fixed with suture, respectively. Horizontal dimension of the furcation defect was the primary outcome measure. Gingival index, probing attachment level (PAL), and vertical dimension of furcation defect were the secondary outcome measures. Clinical parameters were registered at baseline and at 6 months. Results : Every clinical parameter was improved by surgery. Significant gain in PAL as well as horizontal and vertical dimensions of the furcation defects was found. Conclusion: This periosteum displacement technique is effective for the treatment of buccal Grade II furcation defects of lower molars.

Transplante autólogo de condrócitos / Autologous chondrocyte implantation

Esta revisão da literatura descreve o processo do transplante autólogo de condrócitos em todas as suas etapas, indicações clínicas, técnica operatória, técnica laboratorial, reabilitação e resultados clínicos. Desde 1994, quando a técnica de ACI foi descrita pela primeira vez, este procedimento foi aprimorado e tornou-se uma das mais importantes alternativas cirúrgicas para o tratamento das lesões condrais do joelho. Nivel de Evidência II, Prospectivo Comparativo.

This literature review article describes the autologous chondrocyte implantation (ACI) process - its stages, clinical indications, surgical technique, laboratory protocol, rehabilitation and clinical outcomes. Since 1994, when the ACI was described for the first time, the procedure has improved to become one of the most important surgical alternatives for the treatment of chondral lesions of the knee.

Repair of critical-size defects with autogenous periosteum-derived cells combined with bovine anorganic apatite/collagen: an experimental study in rat calvaria

The aim of this study was to evaluate the bone repair using autogenous periosteum-derived cells (PDC) and bovine anorganic apatite and collagen (HA-COL). PDC from Wistar rats (n=10) were seeded on HA-COL discs and subjected to osteoinduction during 6 days. Critical-size defects in rat calvarias were treated with blood clot (G1), autogenous bone (G2), HA-COL (G3) and HA-COL combined with PDC (G4) (n=40), and then analyzed 1 and 3 months after surgeries. Radiographic analysis exhibited no significant temporal change. G1 and G2 had discrete new marginal bone, but the radiopacity of graft materials in G2, G3 and G4 impaired the detection of osteogenesis. At 3 months, histopathological analysis showed the presence of ossification islets in G1, which was more evident in G2, homogeneous new bone around HA-COL in G3 and heterogeneous new bone around HA-COL in G4 in addition to moderate presence of foreign body cells in G3 and G4. Histomorphometric analysis showed no change in the volume density of xenograft (p>0.05) and bone volume density in G2 was twice greater than in G1 and G4 after 3 months (p<0.05), but similar to G3. The PDC did not increase bone formation in vivo, although the biomaterial alone showed biocompatibility and osteoconduction capacity.

O objetivo deste estudo foi avaliar o reparo ósseo usando células derivadas de periósteo (PDC) e apatita inorgânica e colágeno bovinos (HA-COL). PDC de ratos Wistar (n=10) foram semeadas sobre discos de HA-COL e osteoinduzidas por 6 dias. Defeitos de tamanho crítico em calvárias de ratos foram tratados com coágulo sanguíneo (G1), osso autógeno (G2), HA-COL (G3) ou HA-COL associado a PDC (G4) (n=40) e analisados em 1 e 3 meses após as cirurgias. Análise radiográfica não exibiu mudança temporal significante, G1 e G2 tiveram aumento discreto de novo osso marginal, entretanto a radiopacidade dos materiais de enxerto em G2, G3 e G4 prejudicou a detecção de osteogênese. Análise histopatológica mostrou em 3 meses ilhotas de ossificação em G1 que foi maior em G2, novo osso homogêneo ao redor de HA-COL em G3 e novo osso heterogêneo ao redor de HA-COL em G4 além da presença moderada de células gigantes de corpo estranho em G3 e G4. Análise histomorfométrica mostrou a densidade de volume inalterada do xenoenxerto (p>0,05) e a densidade de volume de novo osso em G2 duas vezes maior que G1 e G4 após 3 meses (p<0,05), mas similar a G3. PDC não aumentaram a formação óssea in vivo apesar do biomaterial sozinho ter apresentado biocompatibilidade e capacidade osteocondutora.

El periostio: una alternativa más para obtener buena calidad de matriz ósea orgánica / The periosteum: another alternative to obtain good quality organic bone matrix

Se estudiaron las propiedades osteogénicas del periostio y de los osteoblastos colocados a modo de injerto en cavidades óseas. Se evaluaron aspectos experimentales y sus resultados transferidos a la clínica. En la faz experimental, se emplearon conejos machos de 4.5 kg y de un año de edad, a los que se lesinjertó periostio en cavidades óseas artificiales talladas a tal fin, con su respectivos controles en cada una de las extremidades traseras. El seguimiento radiográfico, la histología convencional y el análisis computarizado de las densidades óseas corroboraron la mayor formación en cantidad de tejido óseo en las cavidades problemas. La investigación clínica permitió establecer la evolución de las cavidades control y problema sin que se experimentara rechazo del injerto aplicado a modo de rollo y a cielo cerrado. Los resultados clínicos y radiográficos demostraron, a través de la comparación de las radiodensidades de las cavidades controles y problemas, que la curación de las heridas óseas ocurre mucho antes que se hagan visibles en las radiografías, ya que la densidad del hueso maduro no es la misma que el hueso osteoide que se está formando.

Periostioplastías e injertos en el cierre de las fisuras palatinas / Periostioplasty and grafts in the closure of oroantral fistulae

La fisura labio alveolopalatina produce un crecimiento deficiente de los procesos maxilares y cuando queda como secuela del tratamiento, una comunicación que se ubica inmediatamente por debajo del piso nasal, dando alteraciones funcionales, estéticas y anatómicas. La periostioplastía primaria es una técnica quirúrgica descripta por Skoog, que trata de resolver la comunicación que se produce en el nivel del paladar primario, formando el piso nasal en las coanas anteriores. Cuando esto no se resuelve, queda como secuela la comunicación anterior, con diversas consecuencias, principalmente caída del ala nasal por falta de sostén del cartílago alar y el escape de aire a ese nivel. En este caso y de acuerdo con la amplitud de la comunicación, se puede realizar la periostiopastía secundaria o la osteoplastía con injerto de hueso autólogo o hueso de banco

Use of tibial periosteum graft in the repair of failed cleft palate

Fifteen patients with oronasal fistula following unsuccessful repair of cleft palate were chosen. They were operated upon using tibial periosteum graft to reinforce the repair of the failed cleft palate. Fourteen cases had satisfactory closure of the defect, while only one patient had a slit shaped defect at the junction of the hard and soft palate. There was a satisfactory bone production at the site of repair and no complications at the donor site were observed. Also, there was a better velopharyngeal competence and improvement in hypernasality

Periósteo autógeno no tratamento da necrose de esclera após exérese de pterígio e betaterapia / Autogenous periosteum in scleral necrosis treatment after pterygium graft and betatherapy

Os autores apresentam um estudo no qual se utiliza o periósteo autógeno como alternativa de enxerto para o tratamento cirúrgico de necrose de esclera e exposiçäo uveal em olhos submetidos a betaterapia após exérese de pterígio. A revisäo da literatura demonstrou que o periósteo autógeno ainda näo havia sido utilizada neste tipo de patologia. A técnica foi empregada em cinco pacientes. Houve boa integraçäo em todos os casos. Como complicaçäo relatam um caso de dellen corneano e um caso de reabsorçäo parcial tardia do enxerto. Ressaltam a necessidade de tratar a necrose escleral para evitar a ocorrência de infecçäo que, frequentemente leva esses olhos a dano funcional irreversível.

Injerto de periostio en las timpanoplastias / Graft of the periosteum in tympanoplasty

Presentamos los resultados obtenidos en 310 pacientes, empleando como injerto el periostio mastoideo en 70 miringoplastias y 240 timpanoplastias, tipo II, III ó IV, realizadas en el Hospital "Ildemaro Salas" del Instituto Venezolano de los Seguros Sociales, en Caracas, durante 10 años, (1975 a 1985), ambas fechas inclusive. De acuerdo a nuestra experiencia, se considera que el injerto de periostio mastoideo es una alternativa para el empleo en las timpanoplastias, dando origen a un neotímpano suficientemente elástico, que evoluciona en un período de meses y medio hacia la formación de una membrana timpánica, indiferenciable de una membrana normal a la simple otoscopia y que responde en forma adecuada a la onda sonora, siendo por lo mismo útil para el cierre de la perforación y la reconstitución de la membrana timpánica en las timpanoplastias

Comportamiento del periostio en el medio Articular y Diseño de un expansor de periostio en conejos

En conejos de New Zeland White entre las 8 y las 16 semana de edad se practicaron 2 experiencias, la primera encaminada a observar el comportamiento de un autógeno de periostio tomado de la tibia y colocado en el medio articular de la cadera y la segunda encaminada a demostrar la tolerancia de un expansor de periostio colocado subperiosticamente en la cara antero lateral de la tibia del conejo con el objeto de obtener mayores zonas dadoras de periostio sin acmbios en la estructura química e histológica del tejido. En el medio articular se hizo denudamiento del cartílago de la cabeza femoral y esta cabeza se recubrió con periostio con el cambiun adosado a la cabeza cruenta. A las 3 y 4 semanas se tomaron biopsias que mostraron la formación de un cartílago hialino recubriendo la cabeza femoral. Los conejos conservaron la movilidad articular y la articulación no se fusionó ni se anquilosó. Radiológicamente se comprobó la presencia de interlínea articular y la no formación de anquilosis ósea. Esta experiencia similar a otras reportadas en la literatura mundial deja abierta la posibilidad de recuperar caderas en los niños que han sufrido enfermedad del cartílago articular de la cabeza femoral. En cuanto al diseño del expansor del periostio demostró que al ser insufladp expande el periostio y extiende la superficie al doble conservando su histología celular. En el expansor no insuflado el periostio forma a su alrededor una capa de hueso que lo absorve y lo aisla