Correction of Severe Secondary Cleft Lip Nasal Deformity.

BACKGROUND: The lower lateral cartilages (LLCs) are key elements for alar and tip support. Repositioning of both LLCs is an effective procedure for correcting a laterally spreading dome of LLCs and drooping nasal tip in cleft lip nasal deformity (CLND). The alar contour graft has become an essential component of rhinoplasty for correcting the concave or collapsed and retracted alar. Herein, onlay cartilage graft was combined with nasal tip plasty to correct hypoplastic cleft lateral crus or alar rim retraction, and with columella strut to obtain better aesthetic outcomes in patients with severe CLND. METHODS: Seven patients with severe secondary unilateral CLND, including hypoplastic cleft lateral crus or alar rim retraction, underwent rhinoplasty from October 2013 to April 2020. Both LLCs were isolated and repositioned approximated medially using tip suture technique combined with columella strut. A septal cartilage onlay graft was applied on the hypoplastic cleft lateral crus. Cartilage graft on the nasal tip was performed to further project and enhance the nasal tip. Photogrammetric evaluation of the operated patients and statistical analysis of the obtained data were performed. RESULTS: The average age at operation was 23.5 (range: 17-36) years. The follow-up period was 6-36 (mean, 14.3) months. All patients were enrolled by photogrammetric evaluation. Height of the medial nostril and short axis of the nostril on the cleft side were increased with a statistical significance of P < 0.05, indicating that depressed ala on the cleft side, which is a feature of CLND, was corrected similar to that of the noncleft side. CONCLUSIONS: The alar contour cartilage graft, as an effective adjunctive technique, improves the alar margin, prevents the alar rim from collapsing, and provides supports to the cleft-side alar rim. It can be a prophylactic measure to prevent postoperative retraction in patients with weakened LLCs. Lower lateral cartilage repositioning, columellar strut, and nasal tip plasty are useful for correcting severe secondary unilateral CLND.

The Effect of Orthognathic Surgery on Changes in Masticatory Muscle Volume in Patients With Facial Asymmetry.

ABSTRACT: The masseter muscle changes remarkably with orthognathic surgery and has a marked influence on the contours of the lower face. If the postoperative volume change of masticatory muscles, including the masseter muscles, can be predicted, it will facilitate preoperative planning and outcome prediction. This study investigated the association of masticatory muscle volume according to the presence or absence of facial asymmetry, and evaluated whether the volume of masticatory muscles, including that of the masseter muscle, changes after orthognathic surgery in facial asymmetry patients.Twenty patients who underwent LeFort I osteotomy and bilateral sagittal segmentation ramus osteotomy (BSSRO) with facial asymmetry between 2011 and 2017 were assigned to the asymmetric group. Additionally, 207 patients with a simple nasal fracture between 2016 and 2019 were included as the common group. Threedimensional computed tomography images were retrospectively analyzed and compared between the asymmetric group and common group.The volume of both temporal and masseter muscles differed according to facial asymmetry, with the asymmetry in the muscle volume increasing in proportion to the degree of facial asymmetry. The difference in masseter volume on the shortened and lengthened sides was significantly reduced after orthognathic surgery, but a difference of about 1 cm 3 remained. Additionally, the masticatory muscle volume on the lengthened side tended to be decreased more than that on the shortened side.Consideration of the postoperative change in the volume of the masticatory muscles may be helpful in planning orthognathic surgery in facial asymmetry patients.

Osteogenesis of 3D-Printed PCL/TCP/bdECM Scaffold Using Adipose-Derived Stem Cells Aggregates; An Experimental Study in the Canine Mandible.

Three-dimensional (3D) printing is perceived as an innovative tool for change in tissue engineering and regenerative medicine based on research outcomes on the development of artificial organs and tissues. With advances in such technology, research is underway into 3D-printed artificial scaffolds for tissue recovery and regeneration. In this study, we fabricated artificial scaffolds by coating bone demineralized and decellularized extracellular matrix (bdECM) onto existing 3D-printed polycaprolactone/tricalcium phosphate (PCL/TCP) to enhance osteoconductivity and osteoinductivity. After injecting adipose-derived stem cells (ADSCs) in an aggregate form found to be effective in previous studies, we examined the effects of the scaffold on ossification during mandibular reconstruction in beagle dogs. Ten beagles were divided into two groups: group A (PCL/TCP/bdECM + ADSC injection; n = 5) and group B (PCL/TCP/bdECM; n = 5). The results were analyzed four and eight weeks after intervention. Computed tomography (CT) findings showed that group A had more diffuse osteoblast tissue than group B. Evidence of infection or immune rejection was not detected following histological examination. Goldner trichrome (G/T) staining revealed rich ossification in scaffold pores. ColI, Osteocalcin, and Runx2 gene expressions were determined using real-time polymerase chain reaction. Group A showed greater expression of these genes. Through Western blotting, group A showed a greater expression of genes that encode ColI, Osteocalcin, and Runx2 proteins. In conclusion, intervention group A, in which the beagles received the additional ADSC injection together with the 3D-printed PCL/TCP coated with bdECM, showed improved mandibular ossification in and around the pores of the scaffold.

The Natural History of Soft Tissue Hypertrophy, Bony Hypertrophy, and Nodule Formation in Patients With Untreated Head and Neck Capillary Malformations.

BACKGROUND: A percentage of patients with capillary malformation (CM) develop soft tissue hypertrophy, bony hypertrophy, and/or nodule formation. OBJECTIVE: To determine the incidence, age of onset, anatomic distribution of soft tissue/bony hypertrophy, and nodule formation in patients with untreated CM. METHODS: A retrospective medical records review of head and neck CM patients presenting to a tertiary referral center over a 7-year period (2004-2011) was performed. RESULTS: Of the 160 patients with CM, 96 demonstrated progression of disease to include either soft tissue/bony hypertrophy or nodule formation. Of these, 87 patients had not received previous treatment and met the inclusion criteria for analysis. On average, soft tissue hypertrophy began at 9 years of age. The V2/maxillary segment was most commonly involved with upper lip hypertrophy being the most prominent. Fourteen percent of the patients also presented with bony hypertrophy, which began at an average age of 15 years. Nodules were present in 38/87 (44%) of patients with an average age of onset of 22 years. CONCLUSION: This study demonstrates the nature progression of CM and quantifies the clinical characteristics of hypertrophy and nodule formation with untreated head and neck CM. Early and continuous treatment is recommended in hopes of preventing CM progression.

A rare complication of reduction malarplasty.

UNLABELLED: In this report, the authors introduce a rare complication after reduction malarplasty in a 21-year-old male patient. The patient underwent two-jaw surgery and reduction malarplasty at a local plastic surgery clinic in December 2012. He presented with mass-like swelling of the left temporomandibular joint (TMJ) and a clicking sound with jaw movement that began 5 months after surgery. Physical examination, ultrasonography, and enhanced facial 3-dimensional computed tomography indicated suspicion of TMJ capsule injury. Therefore, mass excisional biopsy was performed with plate and screw removal. Biopsy results of the excised cystic mass revealed bursitis. The patient's symptoms disappeared after surgery. This is the first report of bursitis as a rare complication after reduction malarplasty. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Anatomical study of the mandibular angle and body in wide mandibular angle cases.

BACKGROUND: Mandibular angle reduction surgery is widely used for aesthetic purposes. Because inferior alveolar nerve injury is a common complication of this surgery, the anatomical location of this nerve must be known before surgery. This study investigated the relative location of the inferior alveolar nerve in mesofacial and brachyfacial groups. METHODS: Panoramic views of patients were divided into Groups A (gonial angle < 120°) and B (gonial angle > 120°). For the analysis, the magnification of each image was standardized and the following parameters were measured: (1) gonial angle; (2) distance from the alveolar ridge at the center of the first and second premolars and first and second molars to (a) the inferior margin of the inferior alveolar canal and (b) the inferior margin of the mandible; (3) distance from the posterior alveolar ridge to the gonial angle and to (a) on the same line; (4) size of the first and second molars. RESULTS: Statistical analysis showed that there were no significant differences (P > 0.05) between Group A and Group B with respect to the distance from the alveolar ridge to the inferior alveolar canal in the first premolar, second premolar, and first molar. The differences between Group A and Group B with respect to the distance from the alveolar ridge to the inferior margin of the mandible for the second premolar, first molar, second molar and gonial angle were 0.7, 1.5, 2.8, and 7.0 mm, respectively (P < 0.05). The differences between Group A and Group B with respect to the distances from the inferior margin of the inferior alveolar canal to the inferior margin of the mandible for the same landmarks were 0.7, 1.1, 1.3, and 5.7 mm, respectively (P < 0.05). CONCLUSION: The difference in length from the alveolar ridge to the mandibular canal between the two groups was minimal, but the length to the gonial angle differed significantly. These results will help reduce inferior alveolar nerve injury during mandibular angle reduction surgery.

Free Vertical Latissimus Dorsi Flap for Tongue Reconstruction After Total Glossectomy.

BACKGROUND/AIM: The tongue is an important anatomical structure, playing an significant role in natural speech, swallowing, and sense of taste. Immediate reconstruction using autologous tissue must be performed following glossectomy for tongue cancer to improve patient quality of life. This study aimed to demonstrate the usefulness of a surgical technique using the free vertical latissimus dorsi flap (FvLDF) for tongue reconstructions using autologous tissue. PATIENTS AND METHODS: Among patients who underwent total glossectomy for tongue cancer from November 2014 to February 2023, we selected 10 patients who underwent immediate tongue reconstruction with a radial free forearm flap (RFFF) or free anterolateral thigh flap and four patients who underwent FvLDF. The patients were compared regarding postoperative function (width of oropharyngeal space in computed tomography, language-speech evaluation), aesthetic results, and features. RESULTS: All four patients who underwent FvLDF showed successful flap survival, with no severe complications. Because vertical incision was made during flap harvest with primary closure possible with the mid-axillary line, donor morbidity was significantly lower in patients who underwent reconstruction with FvLDF than in those who underwent reconstruction with RFFF, and good aesthetic results were obtained. In comparing the oropharyngeal space of patients on neck CT preoperatively and postoperatively, the width increase rate of patients who underwent reconstruction with FvLDF was significantly smaller. FvLDF patients demonstrated good speech and swallowing functions. CONCLUSION: Considering the advantages of reconstruction with FvLDF in terms of features and aesthetic results, this surgical technique may be a reliable alternative technique for tongue defects after glossectomy.

Effect of Breast Silicone Implant Topography on Bacterial Attachment and Growth: An In Vitro Study.

BACKGROUND/AIM: The mechanisms underlying capsular contracture remain unclear. Emerging evidence supports the inflammation hypothesis, according to which bacteria from an adherent biofilm cause chronic inflammation and collagen deposition on the implant and trigger capsular contracture. Our goal was to evaluate the effect of different types of breast implants on the growth of Staphylococcus aureus, S. epidermidis, and Pseudomonas aeruginosa, which are commonly found in biofilms in infection. MATERIALS AND METHODS: Bacteria were grown in tryptic soy broth at 37°C for 2, 6, and 24 h and subsequently incubated for 24 h on 12 shell sections of smooth, nano-, and macrotextured breast implants. After incubation, the solutions were ultrasonicated and bacterial numbers were determined by serial dilution. S. aureus were fixed, washed with phosphate-buffered saline, dehydrated in ethanol, and coated with a platinum film to visualize the presence of biofilms by scanning electron microscopy. RESULTS: The numbers of S. aureus and S. epidermidis attached to the smooth and nanotextured surface implants were significantly lower than those on the macrotextured surface for all incubation times, whereas the number of P. aeruginosa was non-significantly lowest on the nanotextured surface after 24h incubation. Biofilms on smooth and nanotextured implant surfaces showed patchy patterns on scanning electron microscopy in contrast to the continuous pattern detected on macrotextured implants. CONCLUSION: Nanotextured breast implants may limit bacterial growth and thus prevent capsular contracture.

Biologic filler using human fibroblasts and placenta extracts.

Soft tissue augmentation with injectable materials has been a challenging problem for plastic and reconstructive surgeons. Although filler materials have been used for soft tissue augmentation, adverse effects such as inflammation, distortion, and repeated procedures due to absorption still exist. In this study, biologic filler containing human fibroblasts and placenta extracts was developed to overcome these problems as a concept of cell therapy.In an in vivo assay, 40 nude mice were divided into 4 groups: 1 control group and 3 experimental groups. Biologic fillers containing human fibroblasts untreated (control), cultured with 0.1% placenta extract (group 1), cultured with 10% fetal bovine serum (group 2), and cultured with both 0.1% placenta extract and 10% fetal bovine serum (group 3) were used in each groups. Cultured human fibroblasts were injected into the back of each mouse with fibrin glue to maintain the shape and volume. These groups were compared during an 8-week period. The gross, histologic, and biomolecular studies were proceeded to evaluate the effect of biologic filler.In geometric maintenance, volumes in experimental groups were 1.6 (group 1), 1.2 (group 2), and 1.9 times (group 3) more reserved than that in the untreated control group (control) at 8 weeks. In histology, abundant proliferation of fibroblasts as well as extracellular matrices including collagen and glycosaminoglycan was visualized in experimental groups. Enzyme-linked immunosorbent assay was used to analyze collagen and glycosaminoglycan, and reverse transcription-polymerase chain reaction was used to analyze the messenger RNA expression of COL1A1, a gene for collagen type 1, which shows a significant difference between control and experimental groups. There is no statistically significant difference between groups 1 and 2; on the other hand, group 3 statistically has the best outcome among the experimental groups.

A nationwide cohort study on growth impairment by cleft lip with or without palate.

There are very few nationwide studies discussing the height, weight, head circumference, and dental screening of children with cleft lip with or without palate (CL/P), with most reports on this subject based on a 1900s cohort. This study aimed to characterize CL/P children in the 2000s in terms of height, weight, head circumference, and dental screening. This nationwide population-based study evaluated the National Health Insurance Service-Infants and Children's Health Screening (NHIS-INCHS), specifically the height, weight, and head circumference of millions of children. Dental screening data, including the status of each tooth and comprehensive dental judgment, were also evaluated. Syndromic and nonsyndromic CL/P children had lower height, weight, and head circumference than no CL/P children until the age of 66-71 months. Children with cleft palate only or both cleft lip and palate showed similar results. Regarding dental screening, the primary teeth of CL/P children erupted later and fell out faster than no CL/P children. Dental caries was also more common in CL/P children. Children with CL/P had inferior general growth, regardless of palatoplasty surgery. More aggressive dental treatment was required for CL/P children due to the instability of primary teeth and tendency for caries.

Stability of lingual plate osteotomy in orthognathic surgery for patients with severe facial asymmetry: A retrospective analysis with 1-year follow-up.

This study aimed to evaluate the stability of lingual plate osteotomy after sagittal split ramus osteotomy (SSRO) in patients with severe facial asymmetry. It included 20 patients undergoing lingual plate osteotomy between January 2011 and January 2017. Cephalometric X-ray imaging and three-dimensional computed tomography (3DCT) were performed before the operation and then 1 day and 1 year after the operation. The relapse rate and postoperative complications were assessed. The operation time was compared between lingual plate osteotomy and transoral angle osteotomy. Specific values measured on cephalometric X-ray and 3DCT images showed significant changes 1 day after the operation, with 47.9% correction occurring in the occlusal plane angle (mean ± SD = 1.74 ± 0.84°, p < 0.05). However, no significant differences were found between measurements taken 1 day and 1 year after the operation, with a 5% change seen in the occlusal plane angle (mean ± SD = 0.1 ± 0.24°, p = 0.61), suggesting that the surgical outcomes can be well maintained for at least 1 year after surgery. Three patients experienced numbness postoperatively but recovered within 1 year. The operation time for lingual plate osteotomy was shorter than that for transoral angle osteotomy. Our findings indicate that lingual plate osteotomy after SSRO is stable, effective, and safe in patients with severe facial asymmetry.

Surgical approach for venous malformation in the head and neck.

BACKGROUND: Treatment for venous malformations of the head and neck includes sclerotherapy, surgical resection, or a combination of both. Surgical resection can remove or reduce the volume of vascular lesions; however, surgery can cause postoperative scarring and potential surgical complications. This study sought to determine the effectiveness of surgery for the treatment of venous malformations of the head and neck. METHODS: A retrospective review of the medical records of patients who received surgeries for venous malformations of the head and neck from January 2011 to July 2019 was performed. Using clinical photographs, preoperative and postoperative Doppler ultrasonography, outpatient clinic records, and operation records, the postoperative result and complications were evaluated for each case. RESULTS: Among patients who visited our vascular anomalies clinic, 43 patients (ratio of male to female= 24:19) received surgeries for venous malformations of the head and neck. Twenty-nine patients had undergone surgery only, five patients received sclerotherapy after surgery, and nine patients received surgery after preoperative sclerotherapy. In postoperative evaluations, the result was excellent in 24 patients, good in 18 patients, and poor in one patient. Four patients experienced a recurrence of lesions with lagophthalmos, drooping of the corner of the mouth, partial wound necrosis, and scar widening found in one patient each. CONCLUSION: Because the head and neck region is the most exposed area in the body, more active implementation of surgical treatments with or without sclerotherapy is essential to reduce the functional and cosmetic impairments associated with venous malformations.

Usefulness of the LigaSure™ small jaw sealing device for breast reconstruction with a latissimus dorsi flap.

Background: Seromas are the most common complication of latissimus dorsi flap breast reconstruction. Electrocautery for flap elevation can cause seromas and injure the lymph or vessels of the surrounding tissues. Positive effects of the LigaSure Small Jaw (Medtronic [formerly Covidien], Minneapolis, MN, USA) sealing device were examined. Methods: Forty-three latissimus dorsi flap breast reconstruction patients were included. Twenty-three underwent surgery with electrocautery and 21 underwent surgery with LigaSure. The seroma formation rate, total drain volume, drainage indwelling periods at the breast site and donor site, operative time, and hospital stay duration were retrospectively compared. Associations between patient characteristics and these variables were analyzed. Results: Seroma incidence rates were 9/23 (39.1%) and 3/21 (14.3%) for the control and experimental groups. One control group patient underwent surgical treatment; the rest underwent conservative treatment. A significant difference in latissimus dorsi flap elevation time was found between the control and experimental groups (105.6 minutes and 77.1 minutes; p = .026). A significant difference in the drainage indwelling periods of the latissimus dorsi donor site was found (13.1 days and 11 days; p = .006). Excised breast mass weight, latissimus dorsi flap weight, breast drain total volume/indwelling period, and latissimus dorsi drain volume/indwelling period showed statistically significant associations. Radiation and chemotherapy were not significantly associated with any variables. Conclusion: The LigaSure device for latissimus dorsi flap breast reconstruction can reduce seromas, operative time, and hospital stay. It is a reliable and useful surgical sealing device that does not cause injury to the surrounding tissues.

Comparisons among four types of absorbable plates used for internal fixation of zygomaticomaxillary complex fractures.

IMPORTANCE: Conventional plating systems include titanium plates for the fixation of facial bone fractures. However, titanium plates result in artifacts on computed tomography images and appear unstable on magnetic resonance images. Therefore, absorbable plates have been widely used for the fixation of facial bone fractures of late in Asia. OBJECTIVE: To compare stability and symmetry among four different absorbable plates used for internal fixation of zygomaticomaxillary complex fractures. PARTICIPANTS: The subjects were patients with zygomaticomaxillary complex fractures that were diagnosed and treated by internal fixation with absorbable plates between January 2012 and April 2018. Patients aged ≤14 years and ≥76 years were excluded. Patients with other fracture types were also excluded. All patients underwent surgery within 2 weeks of the injury. INTERVENTION: Internal fixation was performed with one of four types of absorbable plates, namely Inion®, Polymax®, Osteotrans®, and Biosorb®. MAIN OUTCOME MEASURES: The stability of the four plates was investigated by evaluation of the orbital height ratio (A'/A), zygoma angle (a'/a), distance (b'/b) from the midline, and gap (c) of the temporal process on three-dimensional facial computed tomography images obtained before, 3 weeks after, and 3-6 months after surgery. Any plate-associated complications were recorded. RESULTS: In total, 400 patients were enrolled, and there were 100 patients in each of the four groups. There were no significant differences with regard to postoperative stability and relapse among the four plates. Moreover, facial symmetry showed no changes over time in any group. Complications such as infection and sensory disturbance were not frequent. All plates except Biosorb® were palpable for more than 6 months after surgery, with Osteotrans® remaining palpable for several years. CONCLUSIONS AND RELEVANCE: Our findings suggest that all four types of absorbable plates are useful for treating isolated zygomaticomaxillary complex fractures. While Biosorb® is unsuitable for severe comminuted fractures. Polymax® and Inion® are not bendable at room temperature. It is important to select an appropriate absorbable plate according to each patient's condition and the fracture severity.

Surface modification of PHBV nanofiber mats for rapid cell cultivation and harvesting.

To maintain the original function of a specific tissue for therapeutic tissue engineering, an advanced cell culture surface for repeat cell proliferation is necessary. We designed a novel cell proliferation and rapid harvesting surface by combining nonwoven nanofiber mat and a thermo-responsive polymer. Nanofibrous poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) mats were fabricated by the electrospinning technique. A poly(N-isopropylacrylamide) (PNIPAM) thermo-responsive layer was grafted on the PHBV nanofiber mat by electron beam irradiation. The average diameter of the PNIPAM-grafted PHBV nanofibers was determined by SEM. ATR-FTIR and ESCA were used to confirm the grafting of PNIPAM onto the PHBV nanofiber surface. Water contact angles on the mats were measured in response to temperature changes. Human adipose-derived stem cells (ADSCs) were cultured on the PNIPAM-grafted PHBV nanofiber mat to investigate cell proliferation, harvesting, and functionality during repeat subculture. Detached ADSCs from each surface by low temperature treatment and trypsin-EDTA were compared by a fluorescence-activated cell sorter (FACS) using expression of stem cell membrane-specific markers such as CD-13 PE, CD-29 PE, and CD-90 FITC. The mass cultivation and intact harvesting of stem cells by low temperature treatment using a thermo-responsive PHBV nanofiber mat is a promising technique for use in regenerative medicine and stem cell therapy.

Surgical indication of Furlow palatoplasty to treat submucous cleft palate.

This study investigated the effects of Furlow palatoplasty on children with submucous cleft palate (SMCP) and identified surgical indications by comparing SMCP and control patients. Twenty-three SMCP children (average age 28.9 months) who were nonsyndromic and underwent surgery between April 2010 and December 2016 were included. Facial computed tomography (CT) was performed preoperatively and at least 1 year postoperatively after a language test. Facial CT measurements were taken for 140 children aged 0-6 years without deformities (control group). Later surgery was associated with more severe nasality. In the coronal view, the difference in the maxillary tuberosity before and after surgery was 3.8 mm (p < 0.05). The height and width of the palatal arch (HNP and WNP) were well maintained (p > 0.05), whereas the angle of the levator veli palatini muscle (ALM) increased (p < 0.05). The nasopharynx was close to normal postoperatively. The distance between the medial pterygoid plates, the HNP, and the WNP were larger in SMCP patients preoperatively (p < 0.05), but these differences disappeared after surgery (p > 0.05). The ALM in SMCP patients was narrower preoperatively, but became flatter postoperatively (p < 0.05), indicating the repositioning of the levator muscle, with improvement of the velopharyngeal function. Furlow palatoplasty is indicated if the HNP and WNP values are larger, and the ALM value is less, in patients with SMCP than in those without.

A murine model of radiation-induced capsule-tissue reactions around smooth silicone implants.

As the availability of breast reconstruction using implants is becoming widespread and many implant recipients undergo radiation therapy, there is an increasing interest in understanding the potential complications associated with capsule-tissue interactions in response to irradiation. Accordingly, our medical institution designed an animal experiment to investigate the effects of irradiation on capsular contracture. A total of 40 mice (C57BL6) were divided into four groups according to whether or not they received irradiation and the time from implantation to irradiation. After each mouse received a specially-fabricated, 1.5 cm semi-spherical silicone implant inserted into the area below the panniculus carnosus, half of the mice were irradiated using singe administration of a 10 Gy dose of radiation (6 MeV). Subsequently, data from gross inspection, histological analysis and immunohistochemical analysis were obtained at one and three months postoperatively and analyzed. Changes that occurred near the capsule led to the phenomenon of contracture subsequent to encapsulation. Our findings suggest that the inflammation reaction occurring near the implant becomes aggravated by 'radiation toxicity' and creates an environment conducive to capsular contracture. The present study demonstrated the process by which the complication of capsular contracture may occur during the treatment of human breast cancer via radiotherapy. These findings may serve as the basis for research and development of future treatments of capsular contracture.

Efficacy of rhBMP-2 Loaded PCL/ß-TCP/bdECM Scaffold Fabricated by 3D Printing Technology on Bone Regeneration.

This study was undertaken to evaluate the effect of 3D printed polycaprolactone (PCL)/ß-tricalcium phosphate (ß-TCP) scaffold containing bone demineralized and decellularized extracellular matrix (bdECM) and human recombinant bone morphogenetic protein-2 (rhBMP-2) on bone regeneration. Scaffolds were divided into PCL/ß-TCP, PCL/ß-TCP/bdECM, and PCL/ß-TCP/bdECM/BMP groups. In vitro release kinetics of rhBMP-2 were determined with respect to cell proliferation and osteogenic differentiation. These three reconstructive materials were implanted into 8 mm diameter calvarial bone defect in male Sprague-Dawley rats. Animals were sacrificed four weeks after implantation for micro-CT, histologic, and histomorphometric analyses. The findings obtained were used to calculate new bone volumes (mm3) and new bone areas (%). Excellent cell bioactivity was observed in the PCL/ß-TCP/bdECM and PCL/ß-TCP/bdECM/BMP groups, and new bone volume and area were significantly higher in the PCL/ß-TCP/bdECM/BMP group than in the other groups (p < .05). Within the limitations of this study, bdECM printed PCL/ß-TCP scaffolds can reproduce microenvironment for cells and promote adhering and proliferating the cells onto scaffolds. Furthermore, in the rat calvarial defect model, the scaffold which printed rhBMP-2 loaded bdECM stably carries rhBMP-2 and enhances bone regeneration confirming the possibility of bdECM as rhBMP-2 carrier.

Generation of histocompatible tissues using nuclear transplantation.

Nuclear transplantation (therapeutic cloning) could theoretically provide a limitless source of cells for regenerative therapy. Although the cloned cells would carry the nuclear genome of the patient, the presence of mitochondria inherited from the recipient oocyte raises questions about the histocompatibility of the resulting cells. In this study, we created bioengineered tissues from cardiac, skeletal muscle, and renal cells cloned from adult bovine fibroblasts. Long-term viability was demonstrated after transplantation of the grafts into the nuclear donor animals. Reverse transcription-PCR (RT-PCR) and western blot analysis confirmed that the cloned tissues expressed tissue-specific mRNA and proteins while expressing a different mitochondrial DNA (mtDNA) haplotype. In addition to creating skeletal muscle and cardiac "patches", nuclear transplantation was used to generate functioning renal units that produced urinelike fluid and demonstrated unidirectional secretion and concentration of urea nitrogen and creatinine. Examination of the explanted renal devices revealed formation of organized glomeruli- and tubule-like structures. Delayed-type hypersensitivity (DTH) testing in vivo and Elispot analysis in vitro suggested that there was no rejection response to the cloned renal cells. The ability to generate histocompatible cells using cloning techniques addresses one of the major challenges in transplantation medicine.

The Effect of a Condylar Repositioning Plate on Condylar Position and Relapse in Two-Jaw Surgery.

BACKGROUND: Numerous condylar repositioning methods have been reported. However, most of them are 2-dimensional or are complex procedures that require a longer operation time and a highly trained surgeon. This study aims to introduce a new technique using a condylar repositioning plate and a centric relation splint to achieve a centric relationship. METHODS: We evaluated 387 patients who had undergone surgery for skeletal jaw deformities. During the operation, a centric relation splint, intermediate splint, final centric occlusion splint, and condylar repositioning plate along with an L-type mini-plate for LeFort I osteotomy or a bicortical screw for bilateral sagittal split ramus osteotomy were utilized for rigid fixation. The evaluation included: a physical examination to detect preoperative and postoperative temporomandibular joint dysfunction, 3-dimensional computed tomography and oblique transcranial temporomandibular joint radiography to measure 3-dimensional condylar head movement, and posteroanterior and lateral cephalometric radiography to measure the preoperative and postoperative movement of the bony segment and relapse rate. RESULTS: A 0.3% relapse rate was observed in the coronal plane, and a 2.8% relapse rate in the sagittal plane, which is indistinguishable from the dental relapse rate in orthodontic treatment. The condylar repositioning plate could not fully prevent movement of the condylar head, but the relapse rate was minimal, implying that the movement of the condylar head was within tolerable limits. CONCLUSIONS: Our condylar repositioning method using a centric relation splint and mini-plate in orthognathic surgery was found to be simple and effective for patients suffering from skeletal jaw deformities.