Bone Reconstruction In Patients Research Articles

Features of Cranial Bone Reconstruction in Patients at Various Stages of Rehabilitation

Background: Postoperative skull bone defects are one of the urgent problems of neurorehabilitation. Skull bone defect limits the scope of rehabilitation measures, complicates patient care, and leads to secondary complications. Significant risks of postop complications demands making a decision about surgery individually. Surgery timing varies widely and remains controversal. Aims: to formulate the features of skull bone defects reconstruction in patients at various stages of rehabilitation based on the analysis of the frequency and structure of postoperative surgical complications. Materials and methods: The retrospective analysis of cranioplasty results was performed in the 129 patients treated in Federal Scientific and Clinical Center of Intensive Care Medicine and Rehabilitology from 2018 to 2022 at various stages of rehabilitation (intensive care, inpatient, outpatient). The features of surgery, frequency and structure of surgical complications dependent on rehabilitation stage were analyzed. Results: A total of 129 patients were included in the study: 84 men (65%) and 45 women (35%). The average age of the patients was 43.213.9 years. The average timing of cranioplasty surgery was 79 days [IQR 60; 133]. Seventy two patients (56%) were operated on at the intensive care stage of rehabilitation, forty (31%) and seventeen (13%) patients were operated on at the inpatient and outpatient stages, respectively. In total, complications occurred in 16 patients (12%). Intensive care patients required careful preoperative preparation, correction of homeostasis and metabolism disorders. In our series, postoperative complications were observed in 12 patients on intensive care stage (17%); all cases of hydrocephalus occurred only in intensive care patients. In patients operated on at the inpatient stage of rehabilitation, complications occurred in 4 cases (10%), while there was no statistically significant difference in the incidence of complications in patients from the intensive care and inpatient subgroups (p=0.334). Complications in patients at the outpatient stage of rehabilitation were not observed in our series. Conclusions: Cranioplasty surgery is possible even in somatically burdened patients at the intensive care stage of rehabilitation. It allows to expand the scope of rehabilitation measures and facilitate medical care. When planning surgical intervention in the early stages after the cranioplasty surgery, it is important to take into account the increased risk of hydrocephalus manifestation.

전정신경초종수술을 위한 경미로접근법에서 컴퓨터 단층촬영 3차원영상합성의 유용성

Background : The purpose of this study was to evaluate the clinical utility of preoperative three-dimensional temporal bone reconstruction in patients for translabyrinthine removal of vestibular schwannoma. Materials and Methods : Prior to commencement of the translabyrinthine approach, critical anatomical structures were traced and three-dimensionally reconstructed using computed tomography (CT) scans of the normal temporal bone. Two patients diagnosed with vestibular schwannoma via magnetic resonance imaging were evaluated in this study. Results : Anatomical reconstruction allowed sequential planning of the translabyrinthine approach. The patient-tailored, preoperative image-guided approach prevented iatrogenic damage by predicting a high jugular bulb or a narrow sinodural angle. Conclusions : Three-dimensional reconstruction illuminates the translabyrinthine approach and identifies difficulties that may be encountered at each step, thus preventing confusion.

New Surgical Technique Using Xenograft as a Microinvasive Method to Avoid Extensive Bone Reconstruction in Patients With Compromised General Health: Promising Surgical Methodology and First Clinical Results

The innovative microinvasive immediate implantation technique of dental implants insertion was described. The technique uses bovine xenograft material to restore the bone defect resulting from teeth pathologies and subsequent extraction. Ten patients had extractions of their premolar upper teeth and immediate implantations with xenograft socket augmentation. This unique procedure allowed primary stability of implant above 70 implant stability quotient in all cases. All of the implants healed without complications and were restored with screwed ceramic crowns. Two-year uneventful follow-ups confirmed alveolar xenograft condensation technique as a microinvasive and safe technique, especially for patients with compromised general health who may not undergo complicated restorative operations.

Reconstruction of Complex Maxillary Defects Using Patient-specific 3D-printed Biodegradable Scaffolds.

Reconstruction of maxilla defects has remained one of the most challenging problems in craniomaxillofacial reconstruction because it typically requires harvesting and grafting of autologous bone, which poses limitations related to the difficulties in accurately reconstructing the defected bone and the highly prolonged duration of surgery. We employed tissue-engineered, patient-specific, 3-dimensional (3D)-printed biodegradable scaffolds for maxillofacial bone reconstruction in patients with complex maxillary defects after surgical removal of cancer. A customized polycaprolactone (PCL) scaffold was designed and fabricated for each patient. For this purpose, we used computer-aided design and manufacturing combined with 3D printing technology. The patients implanted with the PCL scaffolds were followed up for up to 2 years with careful evaluation of morphological changes in the face. We confirmed that the patient-specific 3D-printed PCL scaffold effectively filled the maxillary defect and promoted regeneration of the deficient tissue while remaining stable in the body for a relatively long period. Employing customized tissue-engineered scaffolds built using the patient's computed tomography data and an extrusion-based 3D printing system is safe and clinically feasible, helping create and maintain improved morphological features of the face, which represents the most important aspect from the perspective of the patients.

The Results and Complications of Cranial Bone Reconstruction in Patients With Craniosynostosis

The aim of this study was to report the treatment results and complications of cranial bone reconstruction in patients with craniosynostosis at the Seoul National University Children's Hospital over the 14-year period from 1996 to 2009. A retrospective study was undertaken on 96 cases of 94 consecutive patients diagnosed with craniosynostosis, operated on between 1996 and 2009. The authors collected the data regarding age at surgery, operative time, duration of hospitalization, and follow-up period. Surgical results including the amount of blood loss, signs related to increased intracranial pressure, aesthetic results, cranial index, and complications were evaluated. The authors compared these results with those of the past 10-year period from 1986 to 1995 at the same hospital. There were 81 patients with single synostosis and 13 patients with multiple synostoses. The age of patients ranged from 3 months to 130 months (mean, 27.9 months). The mean operative time was 7.54 ± 1.77 hours. The duration of hospital stay ranged from 5 to 70 days with a mean period of 8.97 days. The intraoperative loss of hemoglobin ranged from 0 to 9.2 g/dL (mean, 2.35 g/dL). The symptoms of increased intracranial pressure were improved after cranioplasty. With regard to aesthetic results, 94 patients were classified into category I and 2 into category IV. The cranial index decreased from 88.0% ± 1.2% to 86.9% ± 1.1% on average. There were 34 minor complications in 28 operations (29.2%). There were statistically significant differences in age at surgery, operative time, duration of hospital stay, and reoperation rate between the recent 14-year study and the past 10-year study. We observed good surgical results and low complications of cranial bone reconstruction in patients with craniosynostosis. The results of the recent 14-year operations were better than those of the past 10-year operations.

Bisphosphonate related osteonecrosis of the jaw – Manifestation in a microvascular iliac bone flap

Bisphosphonate related osteonecrosis of the jaw (BRONJ) is a side effect that may emerge due to a long-term bisphosphonate therapy. Although the timely diagnosis and initiation of treatment are associated with good outcome results, extended cases require whole parts of the jaw to be resected. A possible treatment option is the bony reconstruction of the jaw using microvascular bone flaps. We report, for the first time, the development of a bisphosphonate related osteonecrosis in a microvascular iliac bone graft, a reconstruction that was performed following a partial mandibulectomy due to BRONJ stage III. The observation of BRONJ manifestation in an osseous microvascular transplant is a novel finding that sheds new light on current pathogenesis theories that surround this entity. Furthermore, it is hypothesized that BRONJ is able to progress to adjacent bone. In addition, bone reconstruction in patients suffering from BRONJ may be seen more critically.

O.398 Osseointegration and bone reconstruction in patients affected by ectodermal dysplasia

Diabetes has steadily increased in the past few decades and causes huge influences on human health care and socioeconomic development, and drugs with minimal or no side effects for diabetes are imminent. In the present study, probiotic combination containing five selected probiotics were used to treat diabetes, the high glucose consumption capability and sound probiotic characteristics in vitro showed that the probiotics could consume all glucose within 24 h, and could tolerate low potential of hydrogen (pH) (pH = 2) and high bile salt concentration (0.3%), and they also had sound oxidation resistance [2,2-diphenyl-1-picrylhydrazyl (DPPH),∙O2−, OH, Fe2+ chelation, and the reducing powers] and antibacterial activity, highly adhere to HT-29 cells and markedly reduced the chance for pathogens to adhere to HT-29 cell (p < 0.05) in vitro. Then, the in vivo results further confirmed that probiotic combination had obviously reduced blood glucose in STZ-induced diabetic mice and glucose water-induced diabetic mice, via directly consuming glucose in intestines, increasing the β cell number, the expression of pancreas duodenum homeobox factor-1 (PDX-1), and reduced the expression of glucose transporters of Sodium Glucose Cotransporter 1 (SGLT-1) and Glucose Transporter type2 (GLUT-2) (p < 0.05). Moreover, probiotics had obviously reduced the intestinal permeability via increasing the intestinal mucosal barrier and permeability proteins of Claudin 1 and zonula occludens-1 (ZO-1), reducing the pancreatic inflammation [Toll-like receptors 4 (TLR4), Nuclear transcription factor kBP65 (p65), Interleukin-1β (IL-1β), Tumor Necrosis Factor α (TNF-α), Interleukin-6 (IL-6)] and promoted the cell apoptosis [B-cell lymphoma-2 (Bcl-2)/Bcl-2 Associated X Protein (Bax)]. In conclusion, our group verifies the key role of glucose consumption effect of probiotics, besides its insulin promoting effect and α-glucosidase inhibiting effect.

Advanced Approaches to Alveolar Widening and Vertical Distraction

Alveolar distraction is being used increasingly for alveolar bone reconstruction in patients with severe mandibular defects. Among other surgical techniques such as augmentation and guided bone regeneration procedures vertical distraction of the mandible is a relatively new reconstructive procedure. Since 1996 promising results with this approach have increased its popularity, this mode of treatment is still in the preliminary stages of development.

Distraction osteogenesis of basal mandibular bone for reconstruction of the alveolar ridge

Alveolar distraction is being used increasingly for alveolar bone reconstruction in patients with severe mandibular defects. When there has been total loss of alveolar bone, distraction of the mandibular basal bone is necessary. Distraction osteogenesis is considerably more challenging in mandibular basal bone than in alveolar bone. The low level of the cut increases the technical difficulty and may result in a poor outcome. We describe three cases in which more than 10 mm of distraction of mandibular basal bone was required. Semirigid distraction devices were used to reconstruct the alveolar structures in each case.

Distraction osteogenesis of basal mandibular bone for reconstruction of the alveolar ridge

<h2>Abstract</h2> Alveolar distraction is being used increasingly for alveolar bone reconstruction in patients with severe mandibular defects. When there has been total loss of alveolar bone, distraction of the mandibular basal bone is necessary. Distraction osteogenesis is considerably more challenging in mandibular basal bone than in alveolar bone. The low level of the cut increases the technical difficulty and may result in a poor outcome. We describe three cases in which more than 10mm of distraction of mandibular basal bone was required. Semirigid distraction devices were used to reconstruct the alveolar structures in each case.

Markers of bone turnover in bone metastases

Bone metastases are a frequent complication of cancer disease. The evaluation of metastatic bone disease is crucial for the primary cancer staging because it will influence the therapeutic decision. The diagnosis of bone metastases usually relies on skeletal X-ray and bone scintigraphy. This latter technique is a sensitive diagnostic tool but lacks specificity. Moreover, the assessment of efficacy in the treatment of bone metastasis is difficult because the increased radionucleotide uptake does not always reflect an active metastatic area but may correspond to a bone reconstruction in patients responding to treatment. Markers of bone remodeling could help the clinician in the diagnosis and follow-up of bone metastases. A common feature of both types of bone metastases (lytic or sclerotic) is an alteration of bone remodeling activity. The rate of formation or degradation of the bone matrix can be assessed either by measuring a prominent enzymatic activity of the bone forming or resorbing cells or by measuring bone matrix components released into the circulation during formation or resorption. They have been separated into markers of formation and resorption, but when both events are coupled and in balance, either of these markers will reflect the overall rate of bone turnover. These markers are of unequal specificity and sensitivity, and some of them have not been fully investigated yet in bone metastases. None of these markers is disease specific. Several studies of breast carcinoma showed increased levels of pyridinium cross-links in patients with bone metastases. However, in most studies, breast carcinoma patients without evidence of metastatic bone disease excreted pyridinium cross-links at a much higher rate than healthy controls. Similar findings have been observed with other types of primary cancer including lung, prostate, kidney, throat, and digestive carcinoma. Markers of bone formation had a low sensitivity in the diagnosis of bone metastasis, but they could be useful for prostate carcinoma, in which studies have shown that all patients without bone metastasis had normal value of bone alkaline phosphatase. Bone markers can be used for the follow-up of treatment, especially bisphosphonates therapy. Bisphosphonate infusion induces a large decrease of pyridinium cross-link level. Some studies suggest that a high level of resorption markers after treatment could reflect a resistance to the treatment. Moreover, some studies have shown that level of pyridinium cross-links before treatment could be a predictive factor of the response in multiple myeloma and prostate carcinoma. Bone markers have improved greatly in terms of sensitivity and specificity and could be useful for an early diagnosis of bone metastases. However, the clinical value of the use of bone markers in the diagnosis of bone metastasis has not been clearly shown yet with the possible exception of BPAL in prostate carcinoma. When bone is the only site of metastases, bone markers may be useful for monitoring patients with bone metastases. Markers of bone resorption are sensitive to changes in bone turnover induced by treatment. Bone resorption markers may be particularly useful for the follow-up of bisphosphonate treatment, which is increasingly used in the management of bone metastases.