A new surgical approach to treatment of bilateral syngnathia in a patient with popliteal pterygium-syndrome

This case describes the treatment of syngnathia with a popliteal-pterygium syndrome. Although short-term successful surgical treatment has been described in literature, long-term follow up is essential, as the mouth opening limitations can be repetitively reoccurring. This requires new, individual treatment strategies as demonstrated in this case. A young patient is shown, who is successfully undergoing an alloplastic temporomandibular joint replacement to improve mouth opening, increasing the posterior airway space and facilitating the food intake.

Temporomandibular Joint Osteoarthritis: Regenerative Treatment by a Stem Cell Containing Advanced Therapy Medicinal Product (ATMP)-An In Vivo Animal Trial

Temporomandibular joint osteoarthritis (TMJ-OA) is a chronic degenerative disease that is often characterized by progressive impairment of the temporomandibular functional unit. The aim of this randomized controlled animal trial was a comparative analysis regarding the chondroregenerative potency of intra-articular stem/stromal cell therapy. Four weeks after combined mechanical and biochemical osteoarthritis induction in 28 rabbits, therapy was initiated by a single intra-articular injection, randomized into the following groups: Group 1: AB Serum (ABS); Group 2: Hyaluronic acid (HA); Group 3: Mesenchymal stromal cells (STx.); Group 4: Mesenchymal stromal cells in hyaluronic acid (HA + STx.). After another 4 weeks, the animals were euthanized, followed by histological examination of the removed joints. The histological analysis showed a significant increase in cartilage thickness in the stromal cell treated groups (HA + STx. vs. ABS, p = 0.028; HA + ST.x vs. HA, p = 0.042; STx. vs. ABS, p = 0.036). Scanning electron microscopy detected a similar heterogeneity of mineralization and tissue porosity in the subchondral zone in all groups. The single intra-articular injection of a stem cell containing, GMP-compliant advanced therapy medicinal product for the treatment of iatrogen induced osteoarthritis of the temporomandibular joint shows a chondroregenerative effect.

A short-term plastic adherence incubation of the stromal vascular fraction leads to a predictable GMP-compliant cell-product

Introduction:Mesenchymal stromal/stem cells (MSCs) derived from fat tissue are an encouraging tool for regenerative medicine. They share properties similar to the bone marrow-derived MSCs, but the amount of MSCs per gram of fat tissue is 500x higher. The fat tissue can easily be digested by collagenase, releasing a heterogeneous cell fraction called stromal vascular fraction (SVF) which contains a variable amount of stromal/stem cells. In Europe, cell products like the SVF derived from fat tissue are considered advanced therapy medicinal product (ATMPs). As a consequence, the manufacturing process has to be approved via GMP-compliant process validation. The problem of the process validation for SVF is the heterogeneity of this fraction.

Methods: Here, we modified existing purification strategies by adding an additional plastic adherence incubation of maximal 20 hours after SVF isolation. The resulting cell fraction was characterized and compared to SVF as well as cultivated adipose-derived stromal/stem cells (ASCs) with respect to viability and cell yield, the expression of surface markers, differentiation potential and cytokine expression.

Results: Short-term incubation significantly reduced the heterogeneity of the resulting cell fraction compared to SVF. The cells were able to differentiate into adipocytes, chondrocytes, and osteoblasts. More importantly, they expressed trophic proteins which have been previously associated with the beneficial effects of MSCs. Furthermore, GMP compliance of the production process described herein was acknowledged by the national regulatory agencies (DE_BB_01_GMP_2017_1018).

Conclusion: Addition of a short purification-step after the SVF isolation is a cheap and fast strategy to isolate a homogeneous uncultivated GMP-compliant cell fraction of ASCs.

Skeletal-versus soft-tissue-based cephalometric analyses: is the correlation reproducible?

OBJECTIVES

Dentofacial deformities can be analyzed by skeletal and soft tissue cephalometric analysis (CA). The aim was to evaluate the difference in reproducibility between both methods.

MATERIALS AND METHODS

Lateral cephalograms of 112 patients (65 females and 47 males, 27.7 ± 9.0 years) were oriented in natural head position (NHP) and digitized. The distances of skeletal (SNA, SNB, SnPog) and soft tissue (A', B' and Pog') landmarks relative to the respective norm values and the angles between the Nasion Sella line (NSL) and Frankfurt horizontal (FH) to NHP were measured for statistical evaluation and compared with respective data of an adult control group (CG) with class I occlusion and harmonic facial balance.

RESULTS

The mean differences (mm ± SD) of skeletal and soft tissue landmarks were -2.4 ± 4.4 (A), -7.0 ± 9.3 (B), -6.3 ± 11.2 (Pog), -0.9 ± 1.8 (A'), -4.7 ± 6.2 (B'), and -6.1 ± 7.8 (Pog'), respectively. Pearsons's correlation (r) between the measurements of SNA/A', SNB/B' and SNPog/Pog' were r = .158 (p = .092), r = .662 (p < .001) and r = .655 (p < .001), respectively. The mean (±SD) angles between NSL and FH to NHP were -9.8° ± 5 and 0.0° ± 3.9, respectively.

CONCLUSION

Variability of cranial-based measurements could give a possible explanation for the high variation and the low reproducibility of skeletal cephalometric analysis with soft tissue measurements. Soft-tissue cephalometric analysis would probably improve facial analysis and treatment planning.

Piezosurgery for Sagittal Split Osteotomy: Procedure Duration and Postoperative Sensory Perturbation

PURPOSE

To evaluate piezosurgery for bilateral sagittal split osteotomy (BSSO) for its duration and inferior alveolar nerve (IAN) perturbation.

PATIENTS AND METHODS

In this prospective randomized study, the authors evaluated 100 BSSO procedures in 50 patients. Piezoelectric (group I) and conventional (group II) osteotomies were carried out on each side of the mandible of a patient by 2 specialists. The surgeons had at least 1 year of experience using piezosurgery. The period from incision to complete splitting of the mandibular bone was recorded (ie, procedure duration). The intraoperative status (visibility and relocation) of the IAN also was recorded. The neurosensory function of the IAN was measured by the 2-point discrimination threshold and static light touch methods before surgery and postoperatively (1, 3, and 6 weeks and 6 and 12 months). Parameters were compared between the test groups by the paired t, nonparametric Wilcoxon, or χ² test.

RESULTS

Intergroup comparison showed the mean duration of osteotomy was significantly shorter for group I (17 ± 6 vs 25 ± 9 minutes; P < .001). The rate of intraoperative exposures of the IAN was slightly lower for group I (68%) compared with group II (81%). However, the difference was not relevant. Neurosensory disturbance and recovery of the IAN did not differ between groups.

CONCLUSION

Piezoelectric osteotomy requires considerably less time than conventional mechanical approaches, but shows no advantage in preventing neurosensory perturbation.

The toothpick-tale - Take your patient seriously: a decade of pain and immobilization caused by an unrecognized toothpick!

We report here about a 26-year-old female patient with a 10-year-long saga of pain caused by a toothpick that had pierced through the skin and lodged in her foot but had defied detection for this long period of time. In our department the patient underwent surgery under general anesthesia to remove the foreign body. A 3.7 cm long fragment of a toothpick was extracted. Now the patient is absolutely pain-free and again fully mobile. We tend to over-rely on blood parameters and radiology findings. Especially pain is sometimes not taken seriously enough. Despite the stressful daily routine, listening to the patient and performing a proper clinical examination is core of medical work.

Self-reinforced biodegradable plates and screws for fixation of zygomatic fractures

PURPOSE

The aim of this retrospective clinical study was to evaluate zygomatic fracture fixation with the BioSorbFX osteosynthesis system by assessing stability of reduction as well as complications in the first postoperative year and by conducting a survey to document surgeons' opinions on biodegradable osteosynthesis for this indication.

MATERIAL

From January to September 2003, 25 patients with displaced non-infected unilateral fracture of the zygoma were operated upon (m:f = 20:5; age 17-81 years; mean 39.4 years) using the BioSorbFX 2.0 and/or 1.5 mm osteosynthesis systems.

METHODS

A: Clinical and radiographic examinations were carried out immediately postoperatively and after 1, 3, 6, 9 and 12 months.

METHODS

B: Surgeons were asked to participate in a survey critically evaluating their experience with biodegradable osteosynthesis systems.

RESULTS

A: All fractures of the zygoma healed uneventfully. An excessive soft tissue reaction due to the degradation process was not seen. Three minor complications which resolved after local therapy occurred in the immediate postoperative phase.

RESULTS

B: In the survey, the handling of biodegradable plates in general was rated worse than metal plate osteosynthesis.

CONCLUSION

Fixation of fractures of the zygoma with the BioSorbFX system was simple and safe. The fixations remained stable and bony healing was uneventful. Postoperative complications were few, of a minor nature and not related to the process of biodegradation.