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Acquired Facial, Maxillofacial, and Oral Asymmetries—A Review Highlighting Diagnosis and Management. Symmetry (Basel) 2021. [DOI: 10.3390/sym13091661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Facial asymmetry refers to the absence of, or the deviation from the regular mirror image of facial structures, relative to a referenced midline axis. It can be attributed to a wide spectrum of deformities, including congenital, developmental, or acquired conditions, which can originate either prenatally or postnatally. Though highly prevalent, asymmetry commonly goes undiagnosed due to its subtle or relative nature. Among the spectrum of conditions, acquired cases are triggered postnatally, in previously normal individuals, thus subjecting them to sudden, eventful psychological and psychosocial disharmony. When detected early, timely management may help intervene progressive growth of these conditions. This, therefore, emphasizes the need for a thorough diagnostic workup including medical/dental history, clinical examinations, study models, photographic and radiographic records for a case-by-case basis to prevent severe functional and aesthetic complications. Recently, advanced diagnostic procedures, such as stereophotogrammetry, 3D stereolithographic models, skeletal scintigraphy (radionucleotide scans), 3D computed tomographic scans, cone-beam computed tomography, and magnetic resonance imaging, have provided innovative diagnostic instruments for numerous craniofacial defects. This descriptive review aims at focusing on the factors leading to frequently encountered conditions of acquired facial asymmetry and highlights their clinical evaluation, conservative and surgical interventions by a multi-disciplinary team of clinicians.
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Konofaos P, Wallace RD. Distraction Osteogenesis in Craniofacial Surgery: Past, Present, and Future. J Craniofac Surg 2021; 32:1221-1228. [PMID: 33710057 DOI: 10.1097/scs.0000000000007333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Distraction osteogenesis (DO) is considered one of the treatments of choice for the surgical correction of malformations of the craniofacial skeleton. This is due to its ability to generate bone at the distraction site along with the accompanying soft tissue changes, the possibility to combine DO with traditional orthognathic procedures and the successful reported long-term outcomes following its application to various craniofacial deformities. The aim of this review is to present an overview of the literature on the evolution of DO applications in craniofacial surgery through the last 35 years.
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Affiliation(s)
- Petros Konofaos
- Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN
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AKAY N, AKKAYA S. Distraksiyon ostegenizisi ve maksillofasyal bölge güncel uygulamaları :derleme. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.651475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Distraksiyon osteogenezisi kallusu gererek yeni kemik oluşturma tekniğidir. Bu teknik ilk olarak Rus bilim adamı ortopedist İlizarov tarafından uzun kemiklerde geliştirilmiştir.Distraksiyon osteogenezisi; osteotomi periyodu, latent periyod, distraksiyon periyodu ve konsolidasyon periyodu olmak üzere 4 safhadan oluşmaktadır. Kolay, etkili ve komplikasyonu az olan bir uygulamadır. Distraksiyon osteogenezisi, maksillofasiyal cerrahide yaygın olarak kullanılabilmesi için modifikasyonlara ve geliştirmelere ihtiyaç duyulan bir tekniktir. Distraksiyon osteogenezisi tekniğinin gelişmesi için materyal ve teknik olarak birçok araştırma yapılmıştır ve birçok gelişme kaydedilmiştir. Ancak bu araştırmalar henüz tam bir kesinlik kazanmamakla beraber olumlu sonuçlar vermektedir
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Affiliation(s)
- Neşet AKAY
- Bolu Abant İzzet Baysal Üniversitesi Ağız Diş Çene Cerrahisi Anabilim Dalı
| | - Selda AKKAYA
- Bolu Abant İzzet Baysal Üniversitesi Ağız Diş Çene Cerrahisi Anabilim Dalı
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Comprehensive Treatment of Facial Deformity Due to Radiotherapy in Rhabdomyosarcoma Patients: Distraction Osteogenesis and Free Flaps Surgical Technique. J Craniofac Surg 2019; 30:1275-1279. [PMID: 31033757 DOI: 10.1097/scs.0000000000005338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Radiotherapy is essential for achieving and maintaining local control in head and neck rhabdomyosarcoma patients. However, radiotherapy may cause outgrowth disturbances of facial bone and soft tissue, resulting in facial asymmetry.Several studies have shown that the management of irradiated bones still remains challenging. The possibility of obtaining functional and aesthetic results when managing facial deformities due to radiation therapy with distraction osteogenesis combined with free flaps reconstruction is not common and not well documented in recent literature.In this report, we present the long-term results of distraction osteogenesis and soft tissue reconstruction via microvascular free flap to correct the facial hypoplasia of a young patient who underwent radiation therapy for rhabdomyosarcoma.This is the first presentation of 26 years long-term results in a patient who also underwent free flaps reconstruction as ancillary surgery for esthetic good results.
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Is Distraction Osteogenesis of the Irradiated Craniofacial Skeleton Contraindicated? J Craniofac Surg 2017; 28:1236-1241. [PMID: 28665865 DOI: 10.1097/scs.0000000000003683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Craniofacial distraction osteogenesis (DO) is a common treatment modality today. Despite its numerous advantages, however, concerns have been expressed regarding the use of DO in the irradiated setting. METHODS A systematic review was performed to identify all published reports of patients who underwent DO of the irradiated craniofacial skeleton. The following parameters were of particular interest: postoperative complications, specifically, insufficient bone formation, fracture, and hardware exposure (intraoral and cutaneous), as well as the need for additional bone grafting. RESULTS The initial search retrieved a total of 183 articles of which 20 articles (38 patients) met predetermined inclusion criteria. The most common site of distraction was the mandible (76.3%). The median radiation dose was 50.7 Gy (range, 30-70 Gy). Bone defects ranged from 30 to 80 mm (median, 42.5 mm). Complications were encountered in 19 patients (50%), with insufficient bone formation being most common (9 patients; 23%). The overall incidence of complications was not significantly associated with radiation dosage (P = 0.79). The remaining procedural and demographic variables also failed to meet statistical significance when compared against the overall complication rate (P = 0.27-0.97). CONCLUSION The complication rate associated with craniofacial DO of the irradiated skeleton does not appear to be substantially higher than what is reported for DO in the nonirradiated setting. As such, patients should be offered this treatment modality, particularly in light of the fact, that it offers the option to decrease patient morbidity as well as treatment complexity.
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Momeni A, Rapp S, Donneys A, Buchman SR, Wan DC. Clinical Use of Deferoxamine in Distraction Osteogenesis of Irradiated Bone. J Craniofac Surg 2016; 27:880-2. [PMID: 27171947 PMCID: PMC4902756 DOI: 10.1097/scs.0000000000002633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The deleterious effects of radiotherapy, including hypovascularity and hypocellularity, have made distraction of irradiated bones challenging. Animal studies, however, have demonstrated adjunctive measures such as the administration of deferoxamine to significantly improve bone regeneration across irradiated distraction gaps. In this report, the authors demonstrate, for the first time, enhanced bone formation following deferoxamine application in a patient following distraction of a previously irradiated maxilla. Computed tomography imaging of the pterygomaxillary buttress on the side of administration revealed significantly increased bone area and density relative to the contralateral buttress. This is the first presentation of clinical deferoxamine use to promote bone formation following irradiated bone distraction and highlights the promise for this adjunctive measure to make outcomes after distraction of irradiated bone more reliable.
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Affiliation(s)
- Arash Momeni
- Division of Plastic & Reconstructive Surgery, Stanford University Medical Center, Stanford, CA
| | - Scott Rapp
- Division of Plastic & Reconstructive Surgery, Stanford University Medical Center, Stanford, CA
| | - Alexis Donneys
- Plastic Surgery Section, University of Michigan, Ann Arbor, MI
| | | | - Derrick C. Wan
- Division of Plastic & Reconstructive Surgery, Stanford University Medical Center, Stanford, CA
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Complications of mandibular distraction osteogenesis for acquired deformities: a systematic review of the literature. Int J Oral Maxillofac Surg 2015; 44:956-64. [DOI: 10.1016/j.ijom.2014.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 12/01/2014] [Accepted: 12/04/2014] [Indexed: 11/23/2022]
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Rice N, Polyzois I, Ekanayake K, Omer O, Stassen LF. The management of osteoradionecrosis of the jaws – A review. Surgeon 2015; 13:101-9. [DOI: 10.1016/j.surge.2014.07.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 07/02/2014] [Accepted: 07/04/2014] [Indexed: 01/10/2023]
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Yuhasz MM, Koch FP, Kwiatkowski A, Young C, Clune J, Travieso R, Wong K, Van Houten J, Steinbacher DM. Comparing calvarial transport distraction with and without radiation and fat grafting. J Craniomaxillofac Surg 2014; 42:1412-22. [PMID: 24864072 DOI: 10.1016/j.jcms.2014.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study is to: a) assess transport distraction to reconstruct cranial defects in radiated and non-radiated fields b) examine adipose grafting's effect on the bony regenerate and overlying wound, and c) elucidate sources of bone formation during transport distraction osteogenesis. Twenty-three male New Zealand white rabbits (3 months; 3.5 kg) were used, 10 non-irradiated and 13 irradiated (17 treatment, 6 control) with a one-time fraction of 35 Gy. A 16 × 16 mm defect was abutted by a 10 × 16 mm transport disc 5 weeks after irradiation, and 11 animals were fat grafted at the distraction site. Latency (1 day), distraction (1.5 mm/day), and consolidation (4 weeks) followed. Fluorochromes were injected subcutaneously and microCT, fluorescence, and histology assessed. In distracted animals without fat grafting, bone density measured 701.87 mgHA/ccm and 2271.95 mgHA/ccm in irradiated and non-irradiated animals. In distracted animals with fat grafting, bone density measured 703.23 mgHA/ccm and 2254.27 mgHA/ccm in irradiated and non-irradiated animals. Fluorescence revealed ossification emanating from the dura, periosteum, and transport segment with decreased formation in irradiated animals. Transport distraction is possible for cranial reconstruction in irradiated fields but short-term osseous fill is significantly diminished. Adipose grafting enhances wound healing in previously irradiated fields but does not enhance ossification.
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Affiliation(s)
- Mikell M Yuhasz
- Section of Plastic & Reconstructive Surgery, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - Felix P Koch
- Oral and Maxillofacial Surgery, University Medical Centre Mainz & Research Fellow Plastic Surgery, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - Anna Kwiatkowski
- Section of Plastic & Reconstructive Surgery, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - Calvin Young
- Section of Plastic & Reconstructive Surgery, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - James Clune
- Section of Plastic & Reconstructive Surgery, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - Rob Travieso
- Section of Plastic & Reconstructive Surgery, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - Kenneth Wong
- Section of Plastic & Reconstructive Surgery, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - Joshua Van Houten
- Yale Core Center for Musculoskeletal Disorders, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - Derek M Steinbacher
- Section of Plastic & Reconstructive Surgery, Director of Craniofacial Program, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States.
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Deshpande SS, Monson LA, Cavaliere CM, Ayzengart AL, Buchman SR. Distraction osteogenesis following low-dose hyperfractionated irradiation in the rat mandible. J Oral Maxillofac Surg 2013; 71:1465-70. [PMID: 23866952 DOI: 10.1016/j.joms.2013.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 02/08/2013] [Accepted: 02/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The investigators hypothesized that low-dose hyperfractionated radiation would impair mandibular distraction osteogenesis (DO) in a murine mandibular model. MATERIALS AND METHODS Male Sprague-Dawley rats underwent fractionated radiation (30 Gy) of the left mandible. After a 2-week recovery period, an external frame distractor was applied and gradual distraction of the mandible was performed. Tissue was harvested after a 28-day consolidation period. Gross, radiologic, and histologic evaluations were undertaken. Control animals underwent surgery for an identical time frame without preoperative radiation. RESULTS Animals subjected to preoperative radiation (n = 10) showed suboptimal bone formation, including bone atrophy, incomplete bridging of the distraction gap, and gross bony defects or nonunion, compared with controls (n = 10). Although physical lengthening was achieved, irradiation consistently led to a detrimental effect on the normal process of DO. CONCLUSION This set of experiments establishes a valuable rodent model to evaluate the effects of radiation on DO and may help to formulate strategies to optimize DO before it is widely applied in oncologic reconstruction.
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Affiliation(s)
- Sagar S Deshpande
- Craniofacial Research Laboratory, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48104, USA.
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Bilbao-Alonso A, García-Rielo JM, Varela-Centelles P, Seoane J. Lateral transport osteogenesis in maxillofacial oncology patients for rehabilitation with dental implants: a retrospective case series. Med Oral Patol Oral Cir Bucal 2013; 18:e56-9. [PMID: 22926475 PMCID: PMC3548645 DOI: 10.4317/medoral.18103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 04/23/2012] [Indexed: 12/04/2022] Open
Abstract
Objectives: To report on the use of lateral transport osteogenesis in cancer patients after maxillo/mandibular resections and on the implant survival rate in the generated bone
Material and Methods: Four patients treated using lateral transport osteogenesis entered this descriptive study and were retrospectively studied (mean age 55; range 41-62).
Results: Reconstruction of segmentary defects after surgical and radiological cancer treatment on maxilla and mandible was achieved. No relevant intra- or post-operative complications occurred. No differences on implant survival were observed between patients who had received radiotherapy and those who had not.
Conclusions: This approach can be considered a recommendable reconstructive option after oral cancer treatment –including radiotherapy- particularly for high-surgical-risk, collaborative patients.
Key words:Distraction osteogenesis, oral cancer, radiotherapy, reconstruction, dental implants.
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Affiliation(s)
- Arturo Bilbao-Alonso
- Service of Oral and Maxillofacial Surgery, Santiago de Compostela University Hospital, Santiago de Compostela (A Coruña), Spain
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Liu Y, Chen J, Yan F, Ping F. Mandible reconstruction with transport-disc distraction osteogenesis in children of deciduous dentition. Int J Oral Maxillofac Surg 2012; 41:1223-8. [DOI: 10.1016/j.ijom.2012.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 02/22/2012] [Accepted: 04/26/2012] [Indexed: 11/25/2022]
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Distraction osteogenesis after irradiation in rabbit mandibles. Br J Oral Maxillofac Surg 2012; 50:662-7. [DOI: 10.1016/j.bjoms.2011.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 10/19/2011] [Indexed: 11/15/2022]
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Monson LA, Cavaliere CM, Deshpande SS, Ayzengart AL, Buchman SR. The effects of high dose and highly fractionated radiation on distraction osteogenesis in the murine mandible. Radiat Oncol 2012; 7:151. [PMID: 22958832 PMCID: PMC3494577 DOI: 10.1186/1748-717x-7-151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 07/28/2012] [Indexed: 11/10/2022] Open
Abstract
The ability of irradiated tissue to support bony growth remains poorly defined, although there are anecdotal cases reported showing mixed results for the use of mandibular distraction osteogenesis after radiation for head and neck cancer. Many of these reports lack objective measures that would allow adequate analysis of outcomes or efficacy. The purpose of this experiment was to utilize a rat model of mandibular distraction osteogenesis after high dose and highly fractionated radiation therapy and to evaluate and quantify distracted bone formation under these conditions. Male Sprague–Dawley rats underwent 12 fractions of external beam radiation (48 Gray) of the left mandible. Following a two week recovery period, an external frame distractor was applied and gradual distraction of the mandible was performed. Tissue was harvested after a twenty-eight day consolidation period. Gross, radiologic and histological evaluations were undertaken. Those animals subjected to pre-operative radiation showed severe attenuation of bone formation including bone atrophy, incomplete bridging of the distraction gap, and gross bony defects or non-union. Although physical lengthening was achieved, the irradiated bone consistently demonstrated marked damaging effects on the normal process of distraction osteogenesis. This murine model has provided reliable evidence of the injurious effects of high dose radiation on bone repair and regeneration in distraction osteogenesis utilizing accurate and reproducible metrics. These results can now be used to assist in the development of therapies directed at mitigating the adverse consequences of radiation on the regeneration of bone and to optimize distraction osteogenesis so it can be successfully applied to post-oncologic reconstruction.
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Affiliation(s)
- Laura A Monson
- Craniofacial Research Laboratory, University of Michigan, 2228 BSRB, 109 Zina Pitcher, Ann Arbor 48109, USA
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Zhang WB, Zheng LW, Chua DTT, Cheung LK. Treatment of irradiated mandibles with mesenchymal stem cells transfected with bone morphogenetic protein 2/7. J Oral Maxillofac Surg 2012; 70:1711-6. [PMID: 22580096 DOI: 10.1016/j.joms.2012.01.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE The study aimed to evaluate whether mesenchymal stem cells transfected with bone morphogenetic protein (BMP) 2/7 could increase bone regeneration after radiotherapy using a rabbit model of mandibular distraction osteogenesis. MATERIALS AND METHODS Twelve rabbits were randomly assigned to the sham control, radiotherapy control, nontransfected mesenchymal stem cells (MSCs), and MSCs transfected with BMP-2/7 groups. All rabbits, except those in the sham control group, received preoperative radiation of 9 Gy for 5 fractions. One month after radiotherapy, all rabbits underwent unilateral mandibular distraction at a rate of 0.9 mm/d for 11 days. At the end of active distraction, MSCs combined with bovine collagen were injected into the distraction zone. After 4 weeks of consolidation, the mandibular samples were collected and subjected to radiographic, microcomputed tomographic, and histologic examinations. RESULTS By radiographic examination, animals injected with nontransfected MSCs or MSCs encoding BMP-2/7 exhibited more bone formation than the control groups. Histologic examination showed that the group with MSCs encoding BMP-2/7 had a more mature medullary cavity than the nontransfected MSCs group. CONCLUSIONS MSCs encoding BMP-2/7 can increase bone healing in irradiated mandibular bone.
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Affiliation(s)
- Wen Biao Zhang
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong
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Osseointegrated Implant Rehabilitation of Irradiated Oral Cancer Patients. J Oral Maxillofac Surg 2012; 70:1052-63. [DOI: 10.1016/j.joms.2011.03.032] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 03/13/2011] [Accepted: 03/30/2011] [Indexed: 11/23/2022]
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Korfage A, Stellingsma K, Jansma J, Vissink A, Raghoebar GM. A low-grade myofibroblastic sarcoma in the abdominal cavity. Anticancer Res 2011; 19:1477-80. [PMID: 21750960 PMCID: PMC3151398 DOI: 10.1007/s00520-011-1232-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 07/04/2011] [Indexed: 12/15/2022]
Abstract
Background Rhabdomyosarcoma is the most common malignant tumor in the nasal and paranasal sinus area at childhood. Multimodal treatment for this disorder has severe side effects due to normal tissue damage. As a result of this treatment, facial growth retardation and oral abnormalities such as malformation of teeth and microstomia can cause esthetic and functional problems. Case reports Two cases are presented of patients with severe midfacial hypoplasia and reduced oral function as a result of treatment of rhabdomyosarcoma of the nasopharyngeal and nasal–tonsil region. With a combined surgical (osteotomy, distraction osteogenesis, implants) and prosthetic (implant-based overdenture) treatment, esthetics and function were improved.
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Affiliation(s)
- Anke Korfage
- Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthetics, University Medical Center Groningen, University of Groningen, P.O. Box 30.001-BB70, 9700 RB, Groningen, The Netherlands.
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Nolte JW, Jansma J, Becking AG. Distraction osteogenesis of maxilla and midface in postradiotherapy patients. J Oral Maxillofac Surg 2011; 70:1145-51. [PMID: 21820230 DOI: 10.1016/j.joms.2011.04.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 04/25/2011] [Accepted: 04/26/2011] [Indexed: 10/17/2022]
Affiliation(s)
- Jitske W Nolte
- Department of Oral and Maxillofacial Surgery, VU University Medical Center and Academic Centre of Dentistry, Amsterdam, The Netherlands.
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Customized Bifocal and Trifocal Transport Distraction Osteogenesis Device for Extensive Mandibular Reconstruction. J Craniofac Surg 2011; 22:562-5. [PMID: 21403561 DOI: 10.1097/scs.0b013e318207b539] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Zhang WB, Zheng LW, Chua D, Cheung LK. Bone Regeneration After Radiotherapy in an Animal Model. J Oral Maxillofac Surg 2010; 68:2802-9. [DOI: 10.1016/j.joms.2010.04.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 04/24/2010] [Indexed: 11/17/2022]
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Abstract
PURPOSE OF REVIEW This article reviews the reconstructive techniques commonly employed in temporomandibular joint (TMJ) surgery with an emphasis on recent developments in the field. RECENT FINDINGS TMJ reconstruction remains one of the most challenging tasks faced by surgeons who operate in the head and neck, with a variety of autogenous and alloplastic techniques available. The role of alloplastic TMJ reconstruction needs to be reassessed in light of recent literature showing excellent long-term functional outcomes, which reflect advances in prosthetic materials and surgical technique. More recently, transport distraction osteogenesis has been applied to reconstruction of the ramus-condyle unit with promising early results suggesting it may ultimately become the standard of care in selected patients providing a cost-effective approach with low morbidity and excellent functional outcomes. SUMMARY The myriad of available TMJ reconstructive options reflect the fact that it remains an evolving field. Although no gold standard currently exists, the various techniques each have their own proponents and potential advantages and drawbacks. Ultimately, the reconstructive surgeon must consider the ablative defect and underlying pathology, the needs of the individual patient, the resources of the providing institution and the capabilities of the surgical team.
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Jegoux F, Malard O, Goyenvalle E, Aguado E, Daculsi G. Radiation effects on bone healing and reconstruction: interpretation of the literature. ACTA ACUST UNITED AC 2010; 109:173-84. [PMID: 20123406 DOI: 10.1016/j.tripleo.2009.10.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 09/03/2009] [Accepted: 10/04/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Reconstructing irradiated mandibles with biomaterials is still a challenge but little investigated. We collected data that could help us understand studies in the field of regeneration with biomaterials and irradiated bone. STUDY DESIGN Systematic review of the literature. RESULTS Delay and duration of radiation delivery and total equivalent dose are the most variable parameters in the various studies, resulting in confusion when interpreting the literature. Most reproducible experiments show that radiation reduces osteogenic cell numbers, alters cytokine capacity, and delays and damages bone remodeling. Interindividual variations and how such changes become irreversible lesions are still uncertain. In the case of regeneration using biomaterials, most studies have addressed the question of reconstruction in previously irradiated bone. The results show that osseointegration is often possible, although the failure rate is higher. The sooner the implantation takes place after the end of the radiation, the higher the likelihood of failure. Few studies have focused on primary reconstruction followed by early irradiation, and most of the currently available engineering models would be altered by radiation. Good outcomes have been obtained with bone morphogenetic protein and with total bone marrow transplanation. CONCLUSION This review points out the difficulties in achieving reproducible experiments and interpreting literature in this underinvestigated field.
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Jegoux F, Bedfert C, Alno N, Le Clech G, Daculsi G. Reconstruction mandibulaire en cancérologie : état actuel et perspectives. ACTA ACUST UNITED AC 2009; 126:138-48. [DOI: 10.1016/j.aorl.2009.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 04/17/2009] [Indexed: 11/30/2022]
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Biomechanical assessment of regenerate integrity in irradiated mandibular distraction osteogenesis. Plast Reconstr Surg 2009; 123:114S-122S. [PMID: 19182670 DOI: 10.1097/prs.0b013e318191c5d2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The role of mandibular distraction osteogenesis for reconstructing mandibular defects following radiation therapy depends on the quality of attenuated bone healing in the regenerate. This study investigated the regenerate properties after radiation therapy using yield and breaking load. The authors hypothesized that both would be significantly reduced in mandibular distraction osteogenesis following radiation therapy compared with mandibular distraction osteogenesis alone. METHODS Male Sprague-Dawley rats underwent left mandibular fractionated 36-Gy preoperative external beam radiation therapy and then 2 weeks of recovery (n = 7) or no radiation therapy (n = 10) before surgery. External fixators were secured and unilateral osteotomies were created behind the third molar, followed by 4 days of latency and then mandibular distraction osteogenesis: 0.3 mm every 12 hours for 8 days (5.1 mm) and 4 weeks of consolidation. Unoperated controls received no radiation therapy (n = 13). Mandibles were tension tested at 0.5 mm/second to failure, and yield and breaking load were determined. RESULTS There was a significantly lower breaking load for mandibular distraction osteogenesis following radiation therapy compared with mandibular distraction osteogenesis, alone, but there was no significant difference in yield between the groups. Both groups had significantly lower breaking load and yield when compared with unoperated controls. CONCLUSIONS The lowered breaking load in mandibular distraction osteogenesis following radiation therapy reflects the reduced biomechanical quality of the regenerate, despite evidence of radiographic union. These data show that radiographic union is not an adequate outcome measure for regenerate healing and support the need to define quantitative bone-healing metrics in mandibular distraction osteogenesis following radiation therapy before implementation in head and neck reconstruction.
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Management of osteoradionecrosis of the jaws: An analysis of evidence. Eur J Surg Oncol 2008; 34:1123-34. [DOI: 10.1016/j.ejso.2008.03.014] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 03/26/2008] [Indexed: 11/17/2022] Open
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