Open reduction and internal fixation of mandibular condylar fractures: A national inpatient sample analysis, 2005-2014.

The purpose of this study was to compare outcomes of open reduction and internal fixation (ORIF) versus closed reduction (CR) for mandibular condylar fractures.Patients included in the National Inpatient Sample (NIS) database (2005-2014) who were admitted to the hospital for unilateral mandibular condylar fracture were included in the analysis. Patient characteristics and clinical outcomes were compared between those who received ORIF and those receiving CR. Logistic regression analysis was performed to estimate odds ratios (ORs) for each aspect of the main observed events.NIS data of 12,303 patients who underwent ORIF and 4310 patients who underwent CR were analyzed. Compared to CR, ORIF had an increased risk of longer hospital stay (adjusted OR [aOR] = 1.78, 95% confidence intervals [CIs] = 1.51-2.09), higher total medical cost (aOR = 2.57, 95% CI = 2.17-3.05), and hematoma development (aOR = 10.66, 95% CI = 1.43-75.59), but had a lower risk of having wound complications (aOR = 0.86, 95% CI = 0.79-0.93).Patients with mandibular condylar fractures who receive ORIF have greater risk of having an extended hospital stay, higher total medical costs, and hematoma development but lower risk of experiencing wound complications compared to those who receive CR.

Therapeutic outcomes in the treatment of unilateral glenoid fossa fractures using intermaxillary elastic traction.

INTRODUCTION: This study aimed to evaluate the therapeutic outcomes of intermaxillary elastic traction in the treatment of unilateral glenoid fossa fractures. METHODS: Five patients with traumatic unilateral glenoid fossa fractures were treated with intermaxillary elastic traction at the Sun Yat-Sen University Hospital of Stomatology during a 5-year period from 2006 to 2011. Pantomography and Schüller position radiographs were obtained at days 7, 28, and 90 to monitor glenoid fossa fracture healing. Removal of the intermaxillary elastic traction and the arch bar splint occurred at day 90, and the patients were advised to initiate mouth-opening exercises. RESULTS: Schüller position radiographs revealed a 100% reduction rate of the glenoid fossa fracture for all patients; morphologies of the glenoid fossa and mandibular condyle were normal. Follow-up ranged from 6 months to 2 years. The occlusal relationship (degree of mouth opening) was excellent in all cases. Patient recoveries were uneventful; no complications occurred such as pain, snapping, or limitations of mouth opening. Average mouth opening was measured at 3.6 cm at the last follow-up. CONCLUSIONS: Intermaxillary elastic traction is an effective, simple, and feasible method in the treatment of a glenoid fossa fracture. Accurate reduction and stable fixation may be achieved without significant complications.

Multilineage differentiation of human bone marrow mesenchymal stem cells in vitro and in vivo.

The aim of the present study was to investigate the ability of human bone marrow-derived mesenchymal stem cells (BMSCs) to undergo multilineage differentiation. Human BMSCs were isolated from the ilia of donors by density gradient centrifugation, then purified by adherent separation and cultured in vitro. P3 or P4 BMSC populations were collected and induced for multilineage differentiation into osteoblasts, adipocytes and neuroblasts using an inductive medium in vitro. The BMSCs were cultured in either an osteoblast or chondroblast induction medium, seeded onto porous coral scaffolds and implanted into mice in vivo. The mice were sacrificed by anesthesia overdose at 6 or 9 weeks post-surgery. The scaffolds were then removed for analysis. Lipid vacuoles were observed subsequent to being cultured in an adipogenic medium. These accumulated lipid vacuoles were detected using Sudan Black B and Oil Red O (positive) staining. Deposited calcium was detected using von Kossa and Alizarin Red S (positive) staining subsequent to being cultured in an osteogenic medium. The BMSCs retracted to form neuron-like cells with axon- and dendrite-like processes following induction by ß-mercaptoethanol. The cells were positively stained by toluidine blue and glial fibrillary acidic protein (GFAP) immunohistochemistry. Newly formed bone tissues were observed and islands of cartilage tissue were also formed at 9 weeks post-implantation in vivo. The present study demonstrated that human BMSCs were homogeneous and differentiated with high fidelity to osteogenic, adipogenic, neurogenic or chondrogenic lineages. These cells also form bone and cartilage tissues when implanted in vivo and may therefore be used as seed cells in bone tissue engineering.

[New bone and cartilage tissues formed from human bone marrow mesenchymal stem cells derived from human condyle in vivo].

OBJECTIVE: To investigate the ability to form new bone and cartilage tissues of bone marrow mesenchymal stem cells (BMSC) derived from human condyle in vivo, to search the new source of seed cells in constructing tissue engineering condyle. METHODS: Bone marrow was collected from the irrigation solution from resected human condyle, and was isolated by density gradient centrifugation and then purified by adherent separation and cultured in vitro. P3 or P4 BMSC populations were induced into osteoblasts and chondroblast under inductive medium in vitro and then seeded on porous coral scaffolds. The appearance and affinity of cells were investigated via scanning electron microscope. And then osteoblast or chondroblast/coral scaffolds composites were implanted into the dorsum of nude mice. The mice were sacrificed by anaesthesia overdose at six and nine weeks after surgery and the scaffolds were removed for analysis. RESULTS: Scanning electron microscope showed that BMSC were adhering to the surface of coral and having an overlapped growth or to contact each other as net and stride over the pores. The in vivo scaffold specimens maintained the initial shape of the coral scaffold. The new formed bone tissues were clearly evident and islands of cartilage tissues were also found at nine weeks after implantation. CONCLUSIONS: These BMSC derived from human condyle possess the ability of forming bone and cartilage tissues when being implanted in vivo, and can be used as a kind of seed cells in constructing tissue engineering condyle.

Basic fibroblast growth factor enhances osteogenic and chondrogenic differentiation of human bone marrow mesenchymal stem cells in coral scaffold constructs.

Temporomandibular joint (TMJ) disorders are commonly occurring degenerative joint diseases that require surgical replacement of the mandibular condyle in severe cases. Transplantation of tissue-engineered mandibular condyle constructs may solve some of the current surgical limitations to TMJ repair. We evaluated the feasibility of mandibular condyle constructs engineered from human bone marrow-derived mesenchymal cells (BMSCs). Specifically, human BMSCs were transfected with basic FGF (bFGF) gene-encoding plasmids and induced to differentiate into osteoblasts and chondroblasts. The cells were seeded onto mandibular condyle-shaped porous coral scaffolds and evaluated for osteogenic/chondrogenic differentiation, cell proliferation, collagen deposition and tissue vascularization. Transfected human BMSCs expressed bFGF and were highly proliferative. Osteogenesis was irregular, showing neovascularization around new bone tissue. There was no evidence of bilayered osteochondral tissue present in normal articulating surfaces. Collagen deposition, characteristic of bone and cartilage, was observed. Subcutaneous transplantation of seeded coral/hydrogel hyaluran constructs into nude mice resulted in bone formation and collagen type I and type II deposition. Neovascularization was observed around newly formed bone tissue; bFGF expression was detected in implanted constructs seeded with bFGF expressing hBMSCs. This report demonstrates that engineered porous coral constructs using bFGF gene-transfected human BMSCs may be a feasible option for surgical transplantation in TMJ repair.