Pediatric Myringoplasty using the Periosteum: An Institutional Overview.

Introduction Myringoplasty is a common otologic procedure to restore the integrity of the tympanic membrane in cases of traumatic or pathologic perforations. Many grafting materials have been used with different techniques. Objective In the present work, we evaluate the surgical and audiological outcomes of periosteal graft overlying the mastoid cortex through a retroauricular incision in a pediatric cohort. Methods A retrospective study was carried out involving all children aged ≤ 16 years who underwent periosteal graft myringoplasty for the treatment of chronic suppurative otitis media with dry central perforation in our hospital from April 2019 to April 2021. All patients were followed up for one year to assess the anatomical success and functional outcomes by comparing the preoperative and postoperative (after six months) results of pure tone audiometry (PTA). Results The sample was composed of 36 patients; 20 of them were female (55.6%) and 16 were male (44.4%) subjects, with ages ranging from 7 to 16 (mean: 12.7) years. Four patients underwent surgery in both ears (with an interval of 6 to 9 months). Out of 40 surgeries performed, 38 ears have shown anatomical success (95%). A highly significant improvement in hearing was obtained (the mean difference between the pre- and postoperative results of the PTA was of 14.6 ± 3.45 dB ( p < 0.001). Conclusion We advocate the use of periosteal graft in the pediatric population as a good alternative for other types of grafts, with comparable and even better functional and anatomical outcomes.

A Minimally Invasive Surgical Procedure to Harvest Palate Periosteum as a Source of Mesenchymal Stromal/Stem Cells for Bone Tissue Engineering.

The aim of this study is to validate a minimally invasive surgical procedure to harvest palate periosteum as a source of tissue for mesenchymal stromal/stem cells. We performed a standardized procedure to harvest the palate periosteum in ten subjects, which consisted of a 3 mm disposable punch and a Molt periosteal elevator to harvest a small full-thickness fragment of soft tissue at the hard palate area, between the upper bicuspids, 3 to 4 mm apical to the cement enamel junction. The one-third inner portion was fragmented, and following standard cell culture procedures, the adherent cells were cultured for three passages, after obtaining 70-90% confluence. Cell morphology analysis, flow cytometry analysis, and viability and osteogenic differentiation assays were performed. In all 10 cases, uneventful healing was observed, with no need for analgesic intake. The evaluation of cell morphology showed elongated spindle-shaped cells distributed in woven patterns. A high viability range was verified as well as an immunophenotype compatible with mesenchymal stem cell lineage. The differentiation assay showed the potential of the cells to differentiate into the osteogenic lineage. These results demonstrate that the minimally invasive proposed surgical technique is capable of supplying enough periosteum source tissue for stem cell culture and bone tissue engineering.

Frontoplastia endoscópica subperiostal com fixação temporal por fios de sutura / Subperiosteal endoscopic frontoplasty with temporal suture threads fixation

Introdução: O envelhecimento do terço superior da face se caracteriza por ptose da sobrancelha, rugas glabelares e rugas transversais frontais. O tratamento pode ser realizado através da frontoplastia coronal, da frontoplastia temporal com incisões limitadas e da frontoplastia endoscópica. O objetivo deste estudo é descrever a técnica de frontoplastia endoscópica subperiostal com miotomia dos músculos da região glabelar e fixação do retalho na fáscia temporal profunda, avaliando sua aplicabilidade e eficácia. Métodos: Foram avaliadas 24 pacientes, do sexo feminino, submetidas a frontoplastia endoscópica associada a blefaroplastia superior, com idade variando entre 37 e 72 anos, em um período de 10 anos. Medidas entre a distância da linha interpupilar e a porção superior da sobrancelha foram realizadas através de análise fotográfica com uso do sistema digital de imagem Mirror 6,0, na região medial, central e lateral de cada lado, no pré-operatório, e no pós-operatório de 6 meses. Resultados: A média de idade foi de 52 anos. Houve significância estatística (p<0,05) em todas as áreas da sobrancelha avaliadas, a média de foi de 0,3 cm mais alta. As complicações foram: 1 caso de extrusão fio, 1 caso de assimetria, 2 casos de correção insuficiente da sobrancelha e 2 casos de recidiva de rugas glabelares. Conclusão: A frontoplastia endoscópica subperiostal com miotomia dos músculos da região glabelar e flxação do retalho na fáscia temporal profunda com pontos demonstrou ser efetiva no tratamento do envelhecimento do terço superior da face, com resultados estatisticamente comprovados, baixa morbidade e bons resultados estéticos.

Introduction: The aging of the upper third of the face is characterized by ptosis of the eyebrow, glabellar wrinkles and frontal transverse wrinkles. Treatment can be performed through coronal frontoplasty, temporal frontoplasty with limited incisions and endoscopic frontoplasty. The aim of this study is to describe the technique of subperiosteal endoscopic frontoplasty with myotomy of the muscles of the glabellar region and fixation of the flap in the deep temporal fascia, evaluating its applicability and effectiveness. Methods: Twenty-four female patients who underwent endoscopic frontoplasty associated with upper blepharoplasty, aged between 37 and 72 years old, over a 10-year period were evaluated. Measurements between the distance from the inter-pupillary line and the upper portion of the eyebrow were performed through photographic analysis using the Mirror 6.0 digital image system, in the medial, central and lateral regions on each side, in the preoperative period, and in the 6 month postoperative period. Results: The average age was 52 years. There was statistical significance (p<0.05) in all evaluated eyebrow areas, the mean was 0.3 cm higher. Complications were: 1 case of wire extrusion, 1 case of asymmetry, 2 cases of insufficient correction of the eyebrow and 2 cases of recurrence of glabellar wrinkles. Conclusion: Subperiosteal endoscopic frontoplasty with myotomy of the muscles of the glabellar region and fixation of the flap in the deep temporal fascia with stitches, proved to be effective in the treatment of aging of the upper third of the face, with statistically proven results, low morbidity and good aesthetic results.

Tratamiento del Fisurado Labio Alvéolo Palatino (FLAP): casos clínicos y tratamiento interdisciplinario / Treatment of the cleft lip and palate (CLP) patient: case reports and interdisciplinary treatment

Objetivo: Describir el plan de tratamiento completo para el manejo de pacientes con fisura labio alvéolo palatina (F.L.A.P.), basado en nuestra experiencia clínica de más de 40 años. Casos clínicos: En nuestro protocolo consideramos fundamental el tratamiento ortopédico, teniendo en cuenta los tiempos de crecimiento y desarrollo del maxilar superior de cada paciente, para luego aplicar las técnicas quirúrgicas en un maxilar armónico, con un éxito más predecible. Se describirá una serie de casos clínicos con seguimiento de pacientes. Conclusión: Con este protocolo que pregonamos desde hace muchos años, nos diferenciamos principalmente de otras propuestas por considerar los tiempos biológicos de cada paciente en cuanto a crecimiento y desarrollo, y no por basarnos en tiempos quirúrgicos preestablecidos. Aplicando este protocolo obtenemos resultados predecibles que entendemos que solo son posibles de evaluar, al realizar el seguimiento del paciente hasta completar su desarrollo (AU)

Objective: To describe the comprehensive treatment plan aimed at managing patients with cleft lip and palate (CLP) on the basis of our more than forty years of clinical experience. Case reports: e orthopedic treatment is deemed fundamental in the present protocol, which takes into account the maxilla growth and development periods of each individual patient, to later perform a surgical technique in a harmonized maxilla, with a more predictable success. Clinical cases with the patient follow-up shall be described. Conclusion: e main difference between the present protocol that has been held for many years and others proposed approaches mainly lies in considering the unique growth and developmental biological stages of each patient and not in drawing on pre-established surgical timing. When applying this protocol, predictable results are achieved and they are only meant possible to be assessed during the thorough patient follow-up (AU)

"Periosteum: An imaging review".

Periosteum is a fibrous sheath, coating the external bone, except in the articular surfaces, tendon insertions and sesamoid bone surface¹. It changes its aspects and characteristics with aging, becoming progressively less elastic and more firm. It is composed of two different layers: outer fibrous (firm, collagen-filled) and inner proliferative (cambium, containing osteoprogenitor cells)². Four vascular systems are responsible for the blood supply of the periosteum: the intrinsic periosteal system, located between fibrous and proliferative layer; the periosteocortical, the main nutritional arteries of the periosteum; the musculoperiosteal, responsible for the callus formation after fractures; the fascioperiosteal, specifically for each bone.³ It is crucial to bone formation and resorption, reacting to insults in the cortical bone, such as tumors, infections, traumas, medications and arthritic diseases. The aggressiveness of the reaction can be suggested by its radiological aspect and appearance4. The periosteum in children is looser compared to adults, resulting in earlier and more exuberant reactions. All these aspects will be detailed, so the essential information all radiologists need to know will be discussed.

Phosphorylation of chitosan to improve osteoinduction of chitosan/xanthan-based scaffolds for periosteal tissue engineering.

The periosteum is a membrane that surrounds bones, providing essential cellular and biological components for fracture healing and bone repair. Tissue engineered scaffolds able to function as periosteum substitutes can significantly improve bone regeneration in severely injured tissues. Efforts to develop more bioactive and tunable periosteal substitutes are required to improve the success of this tissue engineering approach. In this work, a chemical modification was performed in chitosan, a polysaccharide with osteoconductive properties, by introducing phosphate groups to its structure. The phosphorylated polymer (Chp) was used to produce chitosan-xanthan-based scaffolds for periosteal tissue engineering. Porous and mechanically reinforced matrices were obtained with addition of the surfactant Kolliphor® P188 and the silicone rubber Silpuran® 2130A/B. Scaffolds properties, such as large pore sizes (850-1097 µm), micro-roughness and thickness (0.7-3.5 mm in culture medium), as well as low thrombogenicity compared to standard implantable materials, extended degradation time and negligible cytotoxicity, enable their application as periosteum substitutes. Moreover, the higher adsorption of bone morphogenetic protein mimic (cytochrome C) by Chp-based formulations suggests improved osteoinductivity of these materials, indicating that, when used in vivo, the material would be able to concentrate native BMPs and induce osteogenesis. The scaffolds produced were not toxic to adipose tissue-derived stem cells, however, cell adhesion and proliferation on the scaffolds surfaces can be still further improved. The mineralization observed on the surface of all formulations indicates that the materials studied have promising characteristics for the application in bone regeneration.

O uso de enxerto e retalho de periósteo em Oftalmologia / The periosteal graft and flap use in Ophthalmology

Resumo Objetivo: Os autores revisaram o uso de periósteo em cirurgias oftalmológicas e seus resultados. Métodos: Uma revisão de literatura usando os bancos de dados do Google Scholar, PubMed e SciElo com todos os artigos sobre o uso de periósteo em Oftalmologia publicados de 1977 até 2018. Resultados: Um total de 21 estudos cumpriram o objetivo do estudo: 9 relatos de caso, 9 séries de casos, 1 coorte retrospective e 2 coortes prospectivas. 206 pacientes foram submetidos aos procedimentos cirúrgicos com uso de periósteo nas duas formas principais: enxerto e retalho. Os principais motivos para uso do periósteo foram: recobrimento de implante orbitário e reconstrução palpebral. Resultados cirúrgicos foram satisfatórios com baixas taxas de complicação de 10.67% e mínima necessidade de nova intervenção cirúrgica de 2.42%. Conclusão: O uso de periósteo em Oftalmologia é uma técnica promissora com bons resultados até o momento e deve sempre ser uma opção terapêutica para o Oftalmologista. Todavia, mais estudos com poder estatístico para sedimentação do conhecimento sobre o tema são recomendados.

Abstract Purpose: The authors reviewed the periosteum use in ophthalmic surgery and its results. Methods: A comprehensive review of the literature using Google Scholar, PubMed and SciElo databases with all articles about the periosteum use in Ophthalmology published from 1977 to 2018. Results: A total of 21 studies followed the review's purpose: 9 case reports, 9 case series, 1 retrospective cohort and 2 prospective cohorts. 206 patients were submitted to the procedures with the periosteum use in the two main forms: graft and flap. The principal reasons for periosteal use were: orbital implant covering and eyelid reconstruction. Surgical outcomes were very satisfactory with low complication rates of 10.67% and minimal necessity of new surgical intervention of 2.42%. Conclusion: The periosteum use in Ophtalmology is a promising technique with good results so far and should always be a therapeutic option for the ophthalmologist. However, based on available data in the literature, more studies with statistical power for knowledge sedimentation in this subject are recommended.

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.

Canine periosteal osteosarcoma / Osteosarcoma periosteal en perro

ABSTRACT Osteosarcoma is the most common bone tumor in dogs. The periosteal osteosarcoma is a subtype of osteosarcoma, and is considered rare in the canine species. The purpose of the present study was to describe a 14-year-old female dog with an ulcerated mass located in the right tibia and 30-days of evolution. The patient was submitted to complementary exams (blood count analysis, dosage of biochemical enzymes - creatinine and alanine aminotransferase, thoracic radiographs, and abdominal ultrasonography) to perform complete staging of the disease. Radiography of the right tibia revealed proliferative and lytic periosteal reaction. The cytological analysis of the mass suggested a round cell tumor. The clinical and the radiological findings indicated the presence of a bone tumor. Pelvic limb amputation was the initial surgical treatment suggested to the client. The histopathological examination revealed the presence of periosteal osteosarcoma with free margins and lymph nodes without evidence of tumor cells. Clinical follow-up was performed through imaging exams without evidence of metastatic disease. The dog had a nine-month survival free time from diagnosis.

RESUMEN El osteosarcoma es el tumor óseo más común en los perros. Osteosarcoma periosteal es un subtipo de osteosarcoma y se considera raro en la especie canina. El objetivo del presente estudio fue describir un caso de una perra mestiza de 14 años de edad con una masa ulcerada y localizada en la tibia derecha y 30 días de evolución. Él paciente se sometió a exámenes adicionales (análisis de sangre, dosis de enzimas bioquímicas - creatinina y alanina aminotransferasa, radiografías torácicas y ultrasonografía abdominal) para la estadificacion completa de la enfermedad. La radiografía de la tibia derecha reveló reacción perióstica proliferativa y lítica. Él examen citológico de la masa sugirió un tumor de celulas redondas. La evaluación clínica y hallazgos radiológicos sugieren la presencia de una neoplasia ósea. La amputación de la extremidad pélvica derecha fue el tratamiento quirúrgico inicial sugerido al cliente. Él examen histopatológico reveló la presencia de osteosarcoma periosteal con márgenes libres y ganglios linfáticos sin evidencia de células tumorales. El seguimiento clínico se realizó a través de exámenes de imágenes sin evidencia de enfermedad metastásica. El perra tenía un tiempo de sobrevida de nueve meses desde el diagnóstico.

Periosteal Graft Myringoplasty: Our Experience.

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.

Diagnostic performance of magnetic resonance imaging in the assessment of periosteal reactions in bone sarcomas using conventional radiography as the reference.

OBJECTIVE: To evaluate the performance of magnetic resonance imaging (MRI) in detecting periosteal reactions and to compare MRI and conventional radiography (CR) in terms of the classification of periosteal reactions. MATERIALS AND METHODS: Retrospective study of 42 consecutive patients (mean age, 22 years; 20 men) with a confirmed diagnosis of osteosarcoma or Ewing's sarcoma, MRI and CR images having been acquired pretreatment. Three blinded radiologists detected periosteal reactions and evaluated each periosteal reaction subtype in CR and MRI images: Codman's triangle; laminated; and spiculated. The CR was used as a benchmark to calculate the diagnostic performance. We used the kappa coefficient to assess interobserver reproducibility. A two-tailed Fisher's exact test was used in order to assess contingency between CR and MRI classifications. RESULTS: In the detection of periosteal reactions, MRI showed high specificity, a high negative predictive value, and low-to-moderate sensitivity. For CR and for MRI, the interobserver agreement for periosteal reaction was almost perfect, whereas, for the classification of different subtypes of periosteal reaction, it was higher for the Codman's triangle subtype and lower for the spiculated subtype. There was no significant difference between MRI and CR in terms of the classifications (p < 0.05). CONCLUSION: We found no difference between MRI and CR in terms of their ability to classify periosteal reactions. MRI showed high specificity and almost perfect interobserver agreement for the detection of periosteal reactions. The interobserver agreement was variable for the different subtypes of periosteal reaction.

OBJETIVO: Avaliar o desempenho da ressonância magnética (RM) na detecção de reação periosteal e comparar a classificação de presença ou ausência de reações periosteais entre a RM e a radiografia convencional (RC). MATERIAIS E MÉTODOS: Estudo retrospectivo incluindo 42 pacientes consecutivos (idade média, 22 anos; 20 homens) com diagnóstico confirmado de osteossarcoma ou sarcoma de Ewing, tendo exames de RM e RC adquiridos pré-tratamento. Três radiologistas avaliaram às cegas a presença ou ausência de reação periosteal e de cada subtipo de reação periosteal nas imagens de RC e RM: triângulo de Codman, multilamelada e espiculada. A RC foi usada como padrão de referência para cálculo do desempenho diagnóstico. Foi utilizado o coeficiente kappa para reprodutibilidade interobservador. Adicionalmente, foi realizado teste exato de Fisher bicaudal para avaliar se houve diferença significativa entre as leituras da RC e RM. RESULTADOS: A RM mostrou alta especificidade, alto valor preditivo negativo e baixa sensibilidade na detecção de reação periosteal. A concordância interobservador para a reação periosteal foi quase perfeita para a RC e RM. A concordância interobservador para a classificação dos diferentes subtipos de reação periosteal foi maior para o subtipo triângulo de Codman e menor para o subtipo espiculada. Não houve diferença na detecção por RM e RC (p < 0,05). CONCLUSÃO: Não houve diferença significativa entre as classificações da presença ou ausência de reações periosteais entre os métodos RC e RM. A RM apresentou alta especificidade e concordância interobservador quase perfeita para a detecção de reação periosteal. A concordância interobservador para os diferentes subtipos de reação periosteal foi variável.

Diagnostic performance of magnetic resonance imaging in the assessment of periosteal reactions in bone sarcomas using conventional radiography as the reference / Desempenho diagnóstico da ressonância magnética na avaliação de reações periosteais em sarcomas ósseos utilizando a radiografia convencional como padrão de referência

Abstract Objective: To evaluate the performance of magnetic resonance imaging (MRI) in detecting periosteal reactions and to compare MRI and conventional radiography (CR) in terms of the classification of periosteal reactions. Materials and Methods: Retrospective study of 42 consecutive patients (mean age, 22 years; 20 men) with a confirmed diagnosis of osteosarcoma or Ewing's sarcoma, MRI and CR images having been acquired pretreatment. Three blinded radiologists detected periosteal reactions and evaluated each periosteal reaction subtype in CR and MRI images: Codman's triangle; laminated; and spiculated. The CR was used as a benchmark to calculate the diagnostic performance. We used the kappa coefficient to assess interobserver reproducibility. A two-tailed Fisher's exact test was used in order to assess contingency between CR and MRI classifications. Results: In the detection of periosteal reactions, MRI showed high specificity, a high negative predictive value, and low-to-moderate sensitivity. For CR and for MRI, the interobserver agreement for periosteal reaction was almost perfect, whereas, for the classification of different subtypes of periosteal reaction, it was higher for the Codman's triangle subtype and lower for the spiculated subtype. There was no significant difference between MRI and CR in terms of the classifications (p < 0.05). Conclusion: We found no difference between MRI and CR in terms of their ability to classify periosteal reactions. MRI showed high specificity and almost perfect interobserver agreement for the detection of periosteal reactions. The interobserver agreement was variable for the different subtypes of periosteal reaction.

Resumo Objetivo: Avaliar o desempenho da ressonância magnética (RM) na detecção de reação periosteal e comparar a classificação de presença ou ausência de reações periosteais entre a RM e a radiografia convencional (RC). Materiais e Métodos: Estudo retrospectivo incluindo 42 pacientes consecutivos (idade média, 22 anos; 20 homens) com diagnóstico confirmado de osteossarcoma ou sarcoma de Ewing, tendo exames de RM e RC adquiridos pré-tratamento. Três radiologistas avaliaram às cegas a presença ou ausência de reação periosteal e de cada subtipo de reação periosteal nas imagens de RC e RM: triângulo de Codman, multilamelada e espiculada. A RC foi usada como padrão de referência para cálculo do desempenho diagnóstico. Foi utilizado o coeficiente kappa para reprodutibilidade interobservador. Adicionalmente, foi realizado teste exato de Fisher bicaudal para avaliar se houve diferença significativa entre as leituras da RC e RM. Resultados: A RM mostrou alta especificidade, alto valor preditivo negativo e baixa sensibilidade na detecção de reação periosteal. A concordância interobservador para a reação periosteal foi quase perfeita para a RC e RM. A concordância interobservador para a classificação dos diferentes subtipos de reação periosteal foi maior para o subtipo triângulo de Codman e menor para o subtipo espiculada. Não houve diferença na detecção por RM e RC (p < 0,05). Conclusão: Não houve diferença significativa entre as classificações da presença ou ausência de reações periosteais entre os métodos RC e RM. A RM apresentou alta especificidade e concordância interobservador quase perfeita para a detecção de reação periosteal. A concordância interobservador para os diferentes subtipos de reação periosteal foi variável.

Recobrimento radicular empregando ativação do periósteo em recessão gengival ampla / Surgical coverage of wide gingival recession using periosteal activation

A recessão gengival caracteriza-se pela migração apical da margem da gengiva, expondo a superfície radicular. Esta condição pode acarretar o desenvolvimento de hiperestesia dentinária, lesões cariosas e/ou comprometimento da estética. O tratamento por cirurgias de recobrimento radicular nem sempre é previsível, especialmente em recessões amplas e profundas, e o deslize lateral do retalho é uma das técnicas que pode ser ou não associada ao enxerto de conjuntivo subepitelial. A ativação do periósteo previamente a essa cirurgia não tem sido muito explorada nas publicações, embora exista há quase 40 anos. Este relato clínico demonstra a associação da técnica do deslize lateral do retalho à ativação do periósteo para recobrimento radicular de recessão ampla classe II de Miller, cuja queixa principal era insatisfação estética e sensibilidade dentinária. O conhecimento biológico e a correta realização da técnica, associados à eliminação do agente etiológico e rigoroso acompanhamento pós-cirúrgico, resultaram no sucesso do tratamento, como atestado pelo controle de um ano e cinco meses.

Gingival recession is characterized by the apical migration of the gingival margin that exposes the dental root surface. This condition can lead to the development of dentinal hyperesthesia, carious lesions and/or aesthetic impairment. The surgical treatment for root coverage not always provides predictable results, especially in wide and deep recessions. The horizontal sliding flap associated or not to subepithelial conjunctive grafts is a commonly employed technique, but periosteal activation prior to surgery has not been much explored in the literature, although it has existed for almost 40 years. This clinical case reports the association of horizontal sliding fl ap with the activation of the periosteum to recover a wide Miller class II recession in a patient complaining of poor aesthetic and dentin sensitivity. The biological knowledge applied to a skillful technique, associated to the elimination of the etiologic agent and rigorous post-surgical follow-up provided a succesful outcome after 1 year and 5 month observations.

Effects of vacuum sealing drainage on the treatment of cranial bone-exposed wounds in rabbits

This study was designed to assess the efficacy of vacuum sealing drainage (VSD) on skull exposure wounds in rabbits and to investigate the underlying mechanism of the process. Full-thickness excisional circular wounds 2×2 cm with or without periosteum involvement were created in 88 New Zealand white rabbits (mean body weight: 3.0±0.65 kg). Animals were randomly divided into 4 groups: periosteum-intact wounds treated with traditional dressing (p+control), periosteum-intact wounds treated with VSD (p+VSD), periosteum-lacking wounds treated with traditional dressing (p-control) and periosteum-lacking wounds treated with VSD (p-VSD). The wounds treated with traditional dressing were covered with Vaseline gauze, while VSD treatment was accompanied with continuous -120 mmHg pressure. Finally, wound tissues were harvested for analysis of hydroxyproline content and histologic detection. VSD hastened the wound healing process significantly (P<0.05) compared to the corresponding control groups. VSD alleviated the inflammation reaction, accelerated re-epithelialization and facilitated the organization of collagen fibers into neat rows. During the wound healing process, the hydroxyproline content increased overtime [i.e., postoperative days (POD) 7, POD 10 and POD 15] in all four groups, and it peaked in the p+VSD group. VSD also promoted angiogenesis via increasing number and quality of collagen. We concluded that VSD can promote healing in bone-exposed wounds via increasing hydroxyproline content and vessel density, reducing inflammatory responses and generating ordered collagen arrangement.

Periostina: su expresión en los procesos de reparación ósea / Periostin expression in bone repair processes: sua expressão nos processos de reparação Óssea / Periostina

La periostina es una proteína no colágena expresada preferentemente en el periostio, que tiene un papel importante en la formación ósea durante la embriogénesis pero también durante la reparación de lesiones óseas o enfermedades metabólicas óseas. En el primer caso, en los procesos de consolidación de fractura, en modelos de animales de experimentación, se observó un incremento de la expresión de periostina inmediatamente posterior a la fractura, lo que sugirió que ésta tendría un papel relevante en la formación del callo óseo periostial durante los estadíos tempranos del proceso de consolidación de fractura. En enfermedades óseas benignas, como la displasia fibrosa, se observó un incremento de la expresión de periostina en el componente fibroso de la lesión, y se la propone como un marcador inmunohistoquímico en los estudios anatomopatológicos. La periostina es un factor soluble que puede ser detectado en sangre periférica. En los últimos años se desarrollaron numerosos inmunoensayos para su medición pero con la limitante que estos miden todas las isoformas circulantes de periostina con lo que se resta especificidad ósea. El desarrollo de nuevos inmunoensayos con mayor especificidad y sensibilidad a los actuales es de crucial importancia para investigar el potencial que tiene la periostina como biomarcador del metabolismo del periostio, calidad y resistencia ósea.

Periostin is a non-collagenous protein expressed mainly in the periosteum, which has an important role during embryonic bone formation but also when repairing bone lesions or metabolic bone diseases. In the first case, when healing fractures and during experimental animal models, a periostin increased expression has been observed immediately after fractures. These findings suggest that periostin may play an important role in periosteal callus formation during the early stage of fracture healing. In benign bone diseases, like fibrous dysplasia, the periostin over-expression was observed in the fibrous component lesion. So, this protein could be detected by immune histochemical technique in histopathology studies. Periostin is a soluble factor, which can be detected in peripheral blood. In recent years, several immunoassays have been developed, though the main limiting factor is the detection of all molecule circulating isoforms, without providing bone specificity. Development of new immunoassays with greater specificity and sensibility than the current ones is crucial to the research concerning the potential of periostin as a biomarker of periosteal metabolism, bone quality and resistance.

Periostina é uma proteína não-colágena que se expressa principalmente no periósteo, o que tem um papel importante na formação óssea durante a embriogênese, mas também durante a reparação de lesões ósseas ou doenças metabólicas ósseas. No primeiro caso, nos processos de consolidação de fratura, em modelos de animais de experimentação, observou-se um aumento na expressão de periostina imediatamente após a fratura, sugerindo que ela teria um papel relevante na formação do calo ósseo periosteal durante as fases precoces do processo de consolidação de fratura. Em doenças ósseas benignas, tais como displasia fibrosa, foi observado um aumento da expressão de periostina no componente fibroso da lesão, propondo-se como um marcador imuno-histoquímico nos estudos anatomo-patológicos. Periostina é um fator solúvel, ele pode ser detectado em sangue periférico tendo sido desenvolvido nos últimos anos inúmeros imunoensaios para sua medição, porém com a limitação de eles medirem todas as isoformas circulantes de periostina tirando-lhe especificidade óssea. Desenvolver novos imunoensaios com maior especificidade e sensibilidade que os atuais é de extrema importância para investigar o potencial que tem a periostina como biomarcador do metabolismo do periósteo, qualidade e ressistência óssea.

Histological image data of limb skeletal tissue from larval and adult Ambystoma mexicanum.

The data presented in this article are related to the article entitled "Cartilage and bone cells do not participate in skeletal regeneration in Ambystoma mexicanum limbs" [1]. Here we present image data of the post-embryonic development of the forelimb skeletal tissue of Ambystoma Mexicanum. Histological staining was performed on sections from the intact limbs of young (6.5 cm) and old (25 cm) animals, and on dissected skeletal tissues (cartilage, bone, and periosteum) from these animals.

Cartilage and bone cells do not participate in skeletal regeneration in Ambystoma mexicanum limbs.

The Mexican Axolotl is one of the few tetrapod species that is capable of regenerating complete skeletal elements in injured adult limbs. Whether the skeleton (bone and cartilage) plays a role in the patterning and contribution to the skeletal regenerate is currently unresolved. We tested the induction of pattern formation, the effect on cell proliferation, and contributions of skeletal tissues (cartilage, bone, and periosteum) to the regenerating axolotl limb. We found that bone tissue grafts from transgenic donors expressing GFP fail to induce pattern formation and do not contribute to the newly regenerated skeleton. Periosteum tissue grafts, on the other hand, have both of these activities. These observations reveal that skeletal tissue does not contribute to the regeneration of skeletal elements; rather, these structures are patterned by and derived from cells of non-skeletal connective tissue origin.

Regression of an ossifying fibroma of the tibia after a fracture involving the lesion. Possible role of the periostina.

Ossifying fibroma (OF) of the long bones is a benign fibro-osseous lesion typically seen in the first decade of life. OF usually progresses until the age of 10 years, but is occasionally found to regress spontaneously after puberty. The pathogenesis of OF is unknown; however, it has been suggested that the basic defect is in the periosteum. We present the radiological course of an OF of the tibia in a young patient, showing a rapid almost complete regression of the lesion after a tibial fracture at the lesion site. We postulate that the fracture-induced activation of the periosteum in a growing skeleton was fundamental to the regression of the lesion.

Papel de la neoformación ósea perióstica en eldesempeno˜ de los criterios CASPAR paradiagnóstico de artritis psoriásica / Role of periosteal new-bone formation in the performance of CASPAR diagnostic criteria for psoriatic arthritis

Objetivo: Determinar el rendimiento de los criterios CASPAR modificados (CASPARm),cuando se remplaza la NFOY por la NFOP.Métodos: Se evaluaron 72 pacientes con psoriasis, 25 de ellos tenían PsA. Se calculó el gradode acuerdo interobservador para la NFOP y la sensibilidad, especificidad y los valores predictivosde la NFOP, NFOY, los criterios CASPAR y CASPARm.Resultados: Se encontró un acuerdo del 87%, kappa 0,56 IC 95% (0,311-0,818). La NFOP fue elsigno radiológico más frecuente con respecto a la NFOY, en los pacientes con PsA: 24/25 vs.7/25. La NFOP tuvo mejor sensibilidad pero menos especificidad en los pacientes con PsA.No hubo diferencia entre la especificidad y sensibilidad en los criterios CASPAR y CASPARm.Conclusiones: La NFOP incluida en los criterios CASPARm puede ser de utilidad en el diagnósticode la PsA. Los 2 sets de criterios podrían ser utilizados en la clasificación de pacientescon PsA. La frecuencia incrementada de la NFOP en pacientes con PsA podría favorecersu inclusión en los criterios de clasificación al facilitar la interpretación del componenteradiológico...

ObjectivesTo determine the changes in the diagnostic performance of the CASPAR criteria when a different radiological finding is included: the periosteal new bone formation (PoBF) in proximal or distal phalanges in conventional X-ray.MethodsA total of 72 patients with psoriasis were evaluated, of whom 25 had psoriatic arthritis (PsA). With the participation of one radiologist and one rheumatologist the interobserver agreement was calculated in order to assess the presence of PoBF. The sensitivity, specificity and predictive values were calculated for: juxta-articular new bone formation (JaBF), PoBF, CASPAR criteria, and CASPAR modified (CASPARm), which included the PoBF as radiological criteria. The reference standard for PsA diagnosis was the clinical judgment of the rheumatologist.ResultsThere was an 87% inter-observer agreement, with a Kappa of 0.56 with 95% CI: 0.311-0.818. PoBF was the most frequent radiological finding in 24/25 compared to JaBF in 7/25 patients. In isolation PoBF had a better sensitivity but lower specificity for discriminating PsA than JaBF. There was no difference between the sensitivity and specificity of CASPAR vs. CASPARm.ConclusionsThe PoBF in the CASPAR criteria may be useful for the classification of PsA. Because there is no difference in sensitivity, specificity and predictive values between CASPAR and CASPARm, the two set of criteria may be used in the diagnosis of psoriatic arthritis. Due to the high frequency of PoBF in patients with PsA and the little impact of this finding in the sensitivity and specificity, the weight given to radiological component in CASPAR criteria should be reassessed, allowing them to adapt better to the behavior of the disease in our environment...

Prognóstico da videocirurgia da região frontal com técnica modificada de fixação / Prognosis of frontal region video surgery with a modified fixation technique

INTRODUÇÃO: A videoendoscopia tem se estabelecido como procedimento de escolha no tratamento da ptose do supercílio e das rugas da região frontal. O acesso minimamente invasivo produz vantagens em relação à tradicional incisão coronal. Diversos métodos de fixação são relatados na literatura, apresentando resultados semelhantes. Nesta série de casos, descrevemos a fixação direta com agulha. OBJETIVO: Avaliar o prognóstico da videocirurgia, utilizando-se a técnica direta com agulha. MÉTODO: Avaliação fotográfica computadorizada de 37 pacientes submetidos à videoendoscopia da região frontal com a fixação direta com agulha, realizada em dois hospitais privados na cidade de Porto Alegre-RS. Resultados: A elevação média do supercílio foi de 5,7 mm no terço lateral e de 4,4 mm no terço medial. Após um pequeno descenso da elevação, no primeiro mês pós-operatório, o reposicionamento do supercílio permaneceu inalterado nas medidas subsequentes até 24 meses. CONCLUSÃO: A fixação direta com agulha é capaz de produzir resultados duráveis, seguros e reprodutíveis no período em que foram realizadas as medições.

INTRODUCTION: Video endoscopy has become a procedure of choice for the treatment of eyebrow ptosis and forehead wrinkles. This minimally invasive technique has several advantages over traditional coronal incision. Several fixation methods are reported in the literature, with similar results. In this study, we describe direct needle fixation. OBJECTIVE: To evaluate the prognosis of video endoscopic surgery using a direct needle technique. METHOD: Computerized photographic evaluations of 37 patients undergoing video endoscopy of the frontal region with needle direct fixation were conducted in two private hospitals in the city of Porto Alegre in Rio Grande do Sul, Brazil. RESULTS: The mean eyebrow elevations were 5.7 and 4.4 mm in the lateral and middle third measurements. After a small dip in elevation in the first month after surgery, the repositioning of the eyebrow remained unchanged in subsequent measurements up to 24 months later. CONCLUSION: Direct needle fixation produced lasting, reliable, and reproducible results during the period in which measurements were made.