Management of Ectropion Associated With a Malunited Zygomaticomaxillary Complex Fracture: A Case Report.

We report the case of a 35-year-old male patient who presented with a right zygomaticomaxillary complex fracture, which was five months old. It was associated with ectropion over the right eye. Diagnosis was made by clinical examination and confirmed by computed tomography, which included a three-dimensional reconstruction view. The patient was concerned about a projecting deformity over the right side of his face and blurring of vision. Surgical rationale of treatment was to easily access the surgical site for the correction of deformity and to achieve the desired facial contour and ectropion correction with uneventful postoperative healing. Deformity at the right zygomatic arch was exposed by a hemicoronal incision. Ectropion over the lower eyelid was addressed by performing Z-plasty. Outcomes were esthetically pleasing with no loss of motor and sensory functions loss. The patient was followed up for six months.

Microvascular decompression using autologous muscle graft for trigeminal neuralgia: a case series and meta-analysis.

PURPOSE: We aimed to describe a case series of patients diagnosed with trigeminal neuralgia (TN) who were submitted to microvascular decompression (MVD) using autologous muscle graft (AMG) and perform a systematic review and meta-analysis. METHODS: Forty-four adult patients who underwent MVD using AMG between 2012 and 2022 were studied retrospectively. Demographic, clinical, and surgical factors were assessed. We systematically reviewed PubMed, Embase, and Cochrane Library from inception to May 2023. We used random-effects model for all outcomes. Heterogeneity was assessed with I2. We used R software 4.3.1 for all statistical analyses. RESULTS: Among patients in the case series, the mean age was 52 ± 12.9 years, and the proportion of females was 65.9%. Forty-one patients (93.2%) presented complete pain relief after a mean follow-up of 7.7 years. The pooled analysis of immediate pain relief was 91.3% (95% CI 82-96%; I2=78%). The good pain relief during follow-up was 88.2% (95% CI 78-94%; I2=80%) at follow-up. The recurrence rates at 6, 12, 36 months, and during follow-up were 6.2%, 10.5%, 10.3%, and 11%, respectively. CONCLUSION: In this case series and meta-analysis of over 440 patients, our findings suggest that the practice of MVD using AMG may be an efficient option in the short term as surgical treatment for TN. Further trials should compare AMG with other materials and its effectiveness in a long-term follow-up.

Combined Pipeline Embolization Device with Endoscopic Endonasal Fascia Lata/Muscle Graft Repair as a Salvage Technique for Treatment of Iatrogenic Carotid Artery Pseudoaneurysm.

The incidence of internal carotid artery (ICA) injury associated with endoscopic endonasal approaches to the pituitary is less than 1%. While parent vessel sacrifice has historically been the choice of treatment, vessel-preserving endovascular techniques have been reported. Although flow diversion offers endoluminal reconstruction, its major limitation is the delay in obtaining complete occlusion. We describe the use of a combined Pipeline embolization device (PED) with endoscopic endonasal repair using a fascia lata/muscle graft to treat an iatrogenic ICA pseudoaneurysm and report long-term radiographic follow-up. Further investigation into the utility of directed endoscopic endonasal repair of iatrogenic pseudoaneurysms initially treated with PED is necessary, especially given the need of post-PED anticoagulation and the rate of permanent neurological deficit after ICA sacrifice.

Evaluation of the regenerative potential of decellularized skeletal muscle seeded with mesenchymal stromal cells in critical-sized bone defect of rat models.

BACKGROUND: The morbidities and complications reported in the reconstruction of large bony defects have inspired progression in the field of bioengineering, with a recent breakthrough for the use of decellularized skeletal muscle grafts (DSMG). AIM: To assess the osteogenic potentials of seeded DSMG in vitro and to investigate bone regeneration in critical size defect in vivo. MATERIALS AND METHODS: Assessment of cell viability and characterization was carried out on seeded DSMG for different intervals in vitro. For in vivo experiments, histological analysis was performed for rat cranial defects for the following groups: (A) non-treated DSMG and (B) seeded DSMG after a period of 8 weeks. RESULTS: The in vitro experiment demonstrated the lack of cytotoxicity and inert properties of seeded DSMG; these facilitated the osteogenic differentiation and significant gene expressions, particularly of COL1A1, RUNX2, and OPN (1.9174 ± 0.11673, 1.1806 ± 0.02383, and 1.1802 ± 0.00775, respectively). In the in vivo experiment, superior results were detected in the seeded DSMG group which showed highly vascularized and cellular dense connective tissue with deposited bone matrix and multiple scattered islets of newly formed bone. CONCLUSION: Our results demonstrated the promising aspects of DSMG; however, there is a lack of studies to support further implications.

Endoscopic Muscle Repair of Right Internal Carotid Artery Rupture Following Endovascular Procedure.

Carotid artery blowout syndrome (CBS) is a deadly complication usually linked to head and neck cancer therapy. We present a different etiology of endoscopic CBS, a complication of endovascular coiling of an intracranial aneurysm, treated with sternocleidomastoid (SCM) muscle graft packing. Case Presentation: An otherwise healthy 55-year-old female presented to the emergency room with right-sided painless vision loss of 23 days. Computed tomography angiography demonstrated a right ophthalmic ICA aneurysm eroding into the right sphenoid sinus with optic nerve compression. Attempted endovascular repair of the aneurysm was complicated by ICA rupture into the sphenoid. An endovascular balloon was inflated proximal to the aneurysm to reduce hemorrhage as ENT performed an endoscopic sphenoidotomy. A hematoma was seen overlying the aneurysm in the superior lateral sphenoid sinus. Layers of SCM muscle were morselized and packed serially. Post-repair angiography showed no further extravasation. Aggressive antiplatelet therapy was initiated. Packing was removed after 14 days. Twenty days postoperatively, the patient had profuse left-sided epistaxis requiring a left sphenopalatine artery ligation. The patient's vision recovered. Discussion: Whereas CBS is often managed by endovascular coil embolism, in our case CBS was caused by this very treatment itself. This case shows the use of SCM muscle graft as an effective repair modality of ICA rupture due to endovascular coiling. Laryngoscope, 131:E764-E766, 2021.

Regenerative peripheral nerve interface free muscle graft mass and function.

BACKGROUND: Regenerative peripheral nerve interfaces (RPNIs) transduce neural signals to provide high-fidelity control of neuroprosthetic devices. Traditionally, rat RPNIs are constructed with ~150 mg of free skeletal muscle grafts. It is unknown whether larger free muscle grafts allow RPNIs to transduce greater signal. METHODS: RPNIs were constructed by securing skeletal muscle grafts of various masses (150, 300, 600, or 1200 mg) to the divided peroneal nerve. In the control group, the peroneal nerve was transected without repair. Endpoint assessments were conducted 3 mo postoperatively. RESULTS: Compound muscle action potentials (CMAPs), maximum tetanic isometric force, and specific muscle force were significantly higher for both the 150 and 300 mg RPNI groups compared to the 600 and 1200 mg RPNIs. Larger RPNI muscle groups contained central areas lacking regenerated muscle fibers. CONCLUSIONS: Electrical signaling and tissue viability are optimal in smaller as opposed to larger RPNI constructs in a rat model.

AAV9 Edits Muscle Stem Cells in Normal and Dystrophic Adult Mice.

CRISPR editing of muscle stem cells (MuSCs) with adeno-associated virus serotype-9 (AAV9) holds promise for sustained gene repair therapy for muscular dystrophies. However, conflicting evidence exists on whether AAV9 transduces MuSCs. To rigorously address this question, we used a muscle graft model. The grafted muscle underwent complete necrosis before regenerating from its MuSCs. We injected AAV9.Cre into Ai14 mice. These mice express tdTomato upon Cre-mediated removal of a floxed stop codon. About 28%-47% and 24%-89% of Pax7+ MuSCs expressed tdTomato in pre-grafts and regenerated grafts (p > 0.05), respectively, suggesting AAV9 efficiently transduced MuSCs, and AAV9-edited MuSCs renewed successfully. Robust MuSC transduction was further confirmed by delivering AAV9.Cre to Pax7-ZsGreen-Ai14 mice in which Pax7+ MuSCs are genetically labeled by ZsGreen. Next, we co-injected AAV9.Cas9 and AAV9.gRNA to dystrophic mdx mice to repair the mutated dystrophin gene. CRISPR-treated and untreated muscles were grafted to immune-deficient, dystrophin-null NSG.mdx4cv mice. Grafts regenerated from CRISPR-treated muscle contained the edited genome and yielded 2.7-fold more dystrophin+ cells (p = 0.015). Importantly, increased dystrophin expression was not due to enhanced formation of revertant fibers or de novo transduction by residual CRISPR vectors in the graft. We conclude that AAV9 effectively transduces MuSCs. AAV9 CRISPR editing of MuSCs may provide enduring therapy.

Surgical management of sacral meningeal cysts by obstructing the communicating holes with muscle graft.

BACKGROUND: The surgical indication and treatment of sacral meningeal cyst have not been well established and current methods are usually accompanied by complications and recurrence. The aim of this study is to discuss the treatment of symptomatic sacral meningeal cyst, by investigating the surgical results of our surgically treated patients, and minimize the complications and recurrence. METHODS: We retrospectively reviewed all patients with symptomatic sacral meningeal cysts who were surgically treated by a single surgeon in the same institution from 2002 to 2017. All patients underwent the same operation by incising the cyst wall and obstructing the communicating hole with muscle graft, while the cyst wall was left untreated instead of resected or imbricated. The obstruction was verified by doing a Valsalva-like maneuver. The preoperative symptoms and signs, and the outcomes at most recent follow-up were rated and compared by Neurological Scoring System. RESULTS: A total of 18 patients (7 male patients and 11 female patients, average age 42.3 years) were followed up for an average of 51.7 months. All patients had communicating holes linking the cysts and the dural sacs. The average preoperative neurological score was 19.7 ± 2.2, and it was improved to 23.2 ± 2.8 at the most recent follow-up (p < 0.01). CONCLUSIONS: The sacral meningeal cyst originated from the communication with the dural sac. Surgical treatment of symptomatic sacral meningeal cysts can yield a long-term resolution of the appropriately selected patient's symptoms. Obstructing the communicating hole with muscle graft is an effective and simple method to obliterate the cyst. The incised cyst wall can be left untreated instead of resected or imbricated.

The Effect of Muscle Graft With Nerve Growth Factor and Laminin on Sciatic Nerve Repair in Rats.

INTRODUCTION: Peripheral nerve injury is one of the most common damages that lead to physical disability. Considering the similarity between the coatings of skeletal muscles and nerve fibers, we conducted this research to determine the effect of muscle graft with Nerve Growth Factor (NGF) and Laminin (L) on nerve repair. METHODS: We cut a 10-mm length of the sciatic nerve from 42 female Wistar rats (Weight: 200±250 g) and equally divided the rats into three groups. In the muscle graft+NGF+laminin group, the degenerated skeletal muscle was sutured with proximal and distal ends of the transected sciatic nerve. Then, NGF (100 ng) and laminin (1.28 mg/mL) were injected into the muscle graft. In the muscle graft group, normal saline was injected into the muscle graft. In the control group, 10 mm of the sciatic nerve was removed without any treatment. Functional recovery was assessed based on Sciatic Functional Index (SFI). Also, tracing motor neurons and histological studies were performed to evaluate nerve repair. The obtained data were analyzed by ANOVA test. RESULTS: The Mean±SD SFI value significantly increased in the muscle graft+NGF+laminin (-76.6±2.9) and muscle graft (-82.1±3.5) groups 60 days after the injury compared to the control group. The Mean±SD number of labeled motor neurons significantly increased in the muscle graft+NGF+laminin (78.6±3.1) and muscle graft (61.3±6.1) groups compared to the control group (P<0.001). The mean number of myelinated axons in the distal segments of the muscle graft+NGF+laminin increased significantly compared to the muscle graft group. CONCLUSION: These findings suggest that muscle graft followed by NGF and laminin administration have therapeutic effects on nerve repair.

Cerebrospinal Fluid Leakage During Temporal Bone Surgery: Selecting Intra-operative Dural Closure with a Dumbbell-Shaped Muscle Graft as a Surgical Approach.

Cerebrospinal fluid (CSF) leakages of the temporal bone may arise during mastoid surgery. The leakages can have multiple potential etiologies, for instance, using a cutting burr near the bony tegmen or monopolar electrocautery on the surface of the dura mater. In this paper, we introduced an effective and simple technique for the management of CSF leakages of the temporal bone. In a prospective case series, 36 patients (16 males and 20 females) who have had an experience of incidental or inevitable CSF otorrhea or otorhinorrhea during temporal bone surgery were selected. All patients were treated using a muscle graft in a dumbbell-shaped design through the dura defect at the Amir-Alam University Hospital between April 2005 and November 2008. The mean size of the defects was 5 mm (a range of 2-10 mm). A dumbbell-shaped autologous muscle graft was immediately successful in sealing the leakage in all patients. Only five patients (13.8%) had some evidence of leakage remaining on the day after the operation, which was subsequently resolved by conservative management in four of them (11.1%). Only one patient (2.7%) was subjected to a second operation for a new defect. Recurrence of CSF leakage or other related complications were not observed during about 7 years of follow up. A free autologous muscle graft, using the dumbbell technique through a small to moderate dura defect is an effective, easily performed, and safe method to seal iatrogenic leakages of the temporal bone.

Evaluation of bone marrow mononuclear cells as an adjunct therapy to minced muscle graft for the treatment of volumetric muscle loss injuries.

BACKGROUND: The delivery of alternative myogenic cell sources to enhance the efficacy of minced muscle grafts (MG) for the treatment of volumetric muscle loss (VML) injuries is a promising strategy to overcome the demand on muscle-derived donor tissue that currently limits the translation of this therapy. METHODS: Using a rat model of VML, bone marrow mononuclear cells (BMNCs) were evaluated for their ability to directly contribute to de novo muscle fiber regeneration by transplanting MG in a collagen carrier at a dose of 50% of the VML injury both with and without concomitant delivery of 5 million BMNCs derived via density gradient centrifugation from the bone marrow of a syngeneic green fluorescent protein (GFP)+ donor. RESULTS: Histological, molecular, and functional analyses revealed that BMNCs can engraft with co-delivered MG and contribute to nascent myofiber, but do so at a low magnitude without resulting in significant changes to transcription of key myogenic genes or gains in whole muscle force generation relative to MG alone. CONCLUSION: As such, co-delivery of BMNCs with MG is a promising treatment paradigm to VML that will require further investigation to identify the phenotype and therapeutic dosing of the bone marrow-derived cell populations which engraft most efficiently.

Enhancement of neural regeneration after spinal cord injury using muscle graft in experimental dogs.

AIMS: Spinal cord injuries (SCIs) can cause severe disability or death. The principal treatments for traumatic SCI include surgical stabilization and decompression. Using muscle as a scaffold is a new approach. The aim of this work is to evaluate the clinical efficacy of muscle graft as a scaffold for the growing axons organizing their growth, preventing gliosis in the damaged area and enhancing neural recovery in canine model of traumatic spinal cord injury. METHODS: 14 dogs were divided into group I (Control group) 4 control dogs subjected to Sham operation, group II (Trauma control group) 5 dogs subjected to dorsal laminectomy with excision of 1 cm segment of the spinal cord and group III (Muscle graft group) 5 dogs subjected to dorsal laminectomy then muscle graft was taken from the longissimus thoraces and inserted into the spinal cord gap. The animals of all groups were euthanatized after 8 weeks. Olby and modified Tarlov scores were used to clinically evaluate the therapeutic effects. Spinal cord specimens were subjected to histological, morphometric and statistical studies. RESULTS: Olby and modified Tarlov scores revealed significant clinical improvement in the muscle graft group. Histological sections showed overgrowth of axons on the muscle graft and the sections started to organize as central gray matter and peripheral white matter. CD44 & CD105 stains were positive for endogenous stem cells. CONCLUSIONS: This study proved the clinical efficacy of muscle grafting as a tool for induction of neuroregeneration after traumatic spinal cord injury.

The use of temporalis muscle graft, fresh and cryopreserved amniotic membrane in preventing temporomandibular joint ankylosis after discectomy in rabbits.

PURPOSE: The aim of the study was to evaluate the efficacy of temporalis muscle-fascia graft, fresh and cryopreserved human amniotic membrane as an interpositional material in preventing temporomandibular joint ankylosis in a rabbit model. MATERIALS AND METHODS: In this experimental study, 21 New Zealand white rabbits were used. The condyle and the joint disc were removed to induce ankylosis in left TMJs. Reconstruction was immediately performed with temporalis muscle-fascia graft (tMFG) in group I (n = 7), fresh human amniotic membrane (fHAM) in group II (n = 7) and cryopreserved human amniotic membrane (cHAM) in group III (n = 7). All rabbits were sacrificed at 3 months after the operation. The comparison was made among three groups by means of vertical mouth opening and weight measurements, radiologic and histologic findings obtained before and after surgery. RESULTS: In all rabbits, there was no statistically significant difference in the jaw movements and weight among groups at commencement and 3 months after surgery. The condylar surfaces were more irregular in HAM groups. There were mild osteophyte formations, sclerosis, fibrosis and calcification around the condyle in all groups however the joint gap was more preserved in group I. All interpositional materials were also seen to be partially present in the joint gap at 3 months. Ankylosis was not seen in the joint gap in any group. CONCLUSION: With the results of this study it was concluded that interpositional arthroplasty with HAM and tMFG have an almost similar effect in preventing TMJ ankylosis after discectomy in the rabbit model.

Autologous minced muscle grafts: a tissue engineering therapy for the volumetric loss of skeletal muscle.

Volumetric muscle loss (VML) results in a large void deficient in the requisite materials for regeneration for which there is no definitive clinical standard of care. Autologous minced muscle grafts (MG), which contain the essential components for muscle regeneration, may embody an ideal tissue engineering therapy for VML. The purpose of this study was to determine if orthotopic transplantation of MG acutely after VML in the tibialis anterior muscle of male Lewis rats promotes functional tissue regeneration. Herein we report that over the first 16 wk postinjury, MG transplantation 1) promotes remarkable regeneration of innervated muscle fibers within the defect area (i.e., de novo muscle fiber regeneration); 2) reduced evidence of chronic injury in the remaining muscle mass compared with nonrepaired muscles following VML (i.e., transplantation attenuated chronically upregulated transforming growth factor-ß1 gene expression and the presence of centrally located nuclei in 30% of fibers observed in nonrepaired muscles); and 3) significantly improves net torque production (i.e., ∼55% of the functional deficit in nonrepaired muscles was restored). Additionally, voluntary wheel running was shown to reduce the heightened accumulation of extracellular matrix deposition observed within the regenerated tissue of MG-repaired sedentary rats 8 wk postinjury (collagen 1% area: sedentary vs. runner, ∼41 vs. 30%), which may have been the result of an augmented inflammatory response [i.e., M1 (CCR7) and M2 (CD163) macrophage expression was significantly greater in runner than sedentary MG-repaired muscles 2 wk postinjury]. These findings support further exploration of autologous minced MGs for the treatment of VML.

Outcome of microvascular decompression for trigeminal neuralgia using autologous muscle graft: A five-year prospective study.

INTRODUCTION: Trigeminal Neuralgia (TGN) is a syndrome characterized by Paroxysmal, shock like hemifacial pain. Among the various treatment options micro vascular decompression (MVD) has gained popularity in the recent years. MATERIALS AND METHODS: 182 patients underwent MVD, between 1995-2007 out of 530 patients treated for Trigeminal Neuralgia at our service. All were operated by retro auricular sub occipital craniectomy by a single surgeon using autologous muscle graft. They were assessed for pain relief, complications and the data was analysed. RESULTS: Males were 84 (61.3%) females 53 (38%) with a ratio of 1.5=1. Age ranged from 25-75 years. Duration of symptoms ranging from 6 months to 25 years (average 4-6 years). Seventy seven (56.2% were affected on the right side whereas 60 (43.8%) had pain on the left side. Imaging demonstrated vascular compression in 84 (61%). At surgery superior cerebellar artery was the commonest cause of compression in 71.5%. More than one artery was found in relation to the nerve in 15.3%. There was no mortality, CSF leak 2.9% and transient facial palsy in 2.2% were the notable complications. CONCLUSION: MVD is the procedure of choice for TGN if there is no contraindication for surgery. Adequate tissue respect, meticulous surgical steps and experience will reduce complications. Autologus muscle graft can give comparable and durable results possibly with lesser complications.

Treatment of temporomandibular joint ankylosis with gap arthroplasty and temporal muscle/fascia graft: a case report with five-year follow-up / Tratamento de anquilose da articulação temporomandibular com artroplastia e enxerto de músculo temporal: Relato de caso com cinco anos de acompanhamento

Purpose: Temporomandibular joint ankylosis (TMA) is a highly distressing condition in which the Temporomandibular Joint (TMJ) is replaced by scar tissue. The most commonly surgical approach used to restore normal joint functioning is a gap arthroplasty associated with the temporal muscle flap (TMF) as interpositional material. This paper aimed to present a modification of the conventional vascularized temporal muscle flap, and describe an alternative procedure using a muscle/fascia temporal graft as interpositional tissue for the gap arthroplasty. Case description: We report a case of TMA treated using a gap arthroplasty and a variation of the TMF technique as interpositional material, performing a temporal muscle/fascia graft. The technique described is associated with adequate bone removal and excellent intraoperative joint mobilization. Physiotherapy was started 2 days after surgery and maintained for 4 months. During the five years of follow-up, no signs of ankylosis recurrence were observed; maximum mouth opening is currently 35 millimeters. Conclusion: The success in preventing reankylosis after TMJ gap arthroplasty is related primarily to the early postoperative physiotherapy, maintained long-term. A free graft harvested from temporal muscle and used as interpositional material is easy to obtain, reliable, and effective. Another advantage is minimal damage to the temporal muscle and low morbidity.

Objetivo: A anquilose da articulação temporomandibular (AATM) é uma condição altamente angustiante aonde a articulação é substituída por tecido cicatricial. A técnica cirúrgica mais comumente usada é a artroplastia associada a um retalho de músculo temporal como um material de interposição entre côndilo/fossa glenóide. Este manuscrito relata um caso de anquilose da articulação temporomandibular tratada pela técnica da artroplastia com uma variação da técnica do retalho do músculo temporal como material interposicional. Descrição do caso: Relatou-se um caso de AATM que foi tratada usando artroplastia com enxerto livre do músculo temporal e fáscia como material interposicional. A técnica descrita está associada a adequada remoção de osso e excelente imobilização articular transoperatória. A fisioterapia foi iniciada 2 dias após a cirurgia e mantida por 4 meses. Durante os 5 anos de controle não houve sinais de recidiva de anquilose; a abertura máxima bucal atualmente é de 35 mm. Conclusão: O sucesso na prevenção da recidiva de anquilose após artroplastia da ATM está primariamente relacionado com fisioterapia pós-operatória precoce, mantida por longo período. Um enxerto livre do músculo temporal usado como material interposicional é fácil de ser obtido, confiável e efetivo. Outra vantagem é dano mínimo ao músculo temporal e baixa morbidade.