Osteoplastic Surgery Research Articles

Management of Facial Alterations in Ollier Disease

Ollier disease, a rare nonhereditary skeletal disorder (1/100,000), is characterized by the occurrence of multiple enchondromas especially in the hands and feet, often of unilateral predominance. The diagnosis is based on clinical and conventional radiologic evaluations. A wait- and -see policy is justified for its treatment because of the risk of chondrosarcoma development. A 42-year-old woman previously diagnosed with Ollier disease, presented with a growth defect on the left side of the face, which disturbed her social life. Computed tomography and radiography assessments demonstrated multiple radiolucent expansive lesions, one on the left mandible and several in the humerus, hand bones, pelvis, and femur. Incisional biopsy was performed in the mandibular lesion. A histopathologic diagnosis of benign fibro-osseous lesion was made. Osteoplastic surgery using an intraoral approach was conducted to improve facial aesthetics. The patient is under outpatient care to evaluate any possible malignant transformation. The prognosis is difficult to assess. Support: FAPEMIG.

BUCCAL AND PALATAL EXOSTOSES CONCURRENT WITH TORI

Although exostoses are not a rare finding, relatively few reports on these structures are available. The information on the concurrence of tori with exostoses is very limited because of the scarcity of cases reported in the literature. Herein we report a case of multiple buccal and palatal exostosis concurrent with maxillary and mandible in a feoderma 37-year-old male patient. The case was successfully managed by multiple elective osteoplastic surgery and no recurrence was detected after 1 year of follow-up. The etiology of the coexistence of multiple exostoses and tori is not yet definitely established in the literature. The absence of local clinical factors, such as occlusal trauma or periodontal disease in this case, raise suspicions that multifactorial genetic and functional factors may be responsible for the development of this condition.

Brushite cement based on β-TCP for orthopedics

The phase composition of brushite cement that is based on β-tricalcium phosphate (β-TCP) and monocalcium phosphate monohydrate (MCPM) is optimized. It is shown that an increase in the β-TCP/MCPM ratio from 1.0 to 1.35 leads to a 20% increase in the cement compressive strength. We assume that this is due to reinforcement of the cement with ceramic particles of β-TCP. Carbonated hydroxyapatite (CHA) granules that are introduced into the cement composition in the amount of 10 wt % also lead to a 20% increase in the cement compressive strength. The cement that is investigated is promising for use in osteoplastic surgery for healing of bone tissue defects that result from trauma and extensive surgery.

Treatment of Chronic Bone Infections Using the Collagen Based Haemostatic - Collatamp G

Treating chronic bone infection is challenging, requiring complete excision of the affected areas and antimicrobial therapy. Acquiring active concentrations of antibiotics is difficult, as well as filling up bone defects resulting from sequestrectomy, and very few methods of treatment address both issues simultaneously. The authors describe the clinical results after using Collatamp G, a collagen-based, antibiotic filled sponge with two actions: local delivery of high antibiotic doses without systemic side effects and enhancement of healing due to collagen, thus covering the bone defect without any further osteoplastic surgery. This paper thus identifies Collatamp G as a biomaterial able to solve the above mentioned problems in treating bone infections.Keywords: bone infections, collagen matrix, gentamicine, antibiotic delivery

A modified bone lid for osteoplastic surgery of the maxillary sinus

Major problems associated with the use of a bone lid for osteoplastic surgery of the maxillary sinus, as first described by Lindorf, are the possibility of postoperative dislocation of the bony fragment into the sinus (floating bone), as well as inflammatory resorption or fracture of the very thin removed trap door fragment. We describe a technique that prevents dislocation of the bone lid and allows for very good visualization of the entire sinus by a simple extended design and the use of resorbable pins. With the use of this extended bone lid, the removal of severely dislocated teeth, implants, sinus pathologies, or foreign bodies can be performed easily. Furthermore, this is an advantageous approach for large orbital fractures, especially those of the posterior half.

Intradiploic hematoma of the frontal bone with secondary exophthalmos in a mare

A 13-year-old cob mare was presented with exophthalmos and periocular swelling of the left eye. The diagnostic work-up included ocular ultrasound, sonographic examination through the thinned frontal bone, radiography, standing computed tomography of the skull and exploratory osteoplastic surgery. Histopathology was consistent with an organized hematoma. An intradiploic hematoma of the frontal bone was diagnosed 5 years after head trauma, with progressive expansion and deformation of the skull resulting in exophthalmos. Exophthalmos with facial bone deformation was the only clinical finding of intradiploic hematoma. Standing computed tomography (CT) aided the diagnosis to differentiate intradiploic hematoma from other, more common causes of facial bone distortion associated with paranasal sinus diseases. Intradiploic hematoma of possible traumatic origin is a differential diagnosis for sinonasal disease and exophthalmos in the horse.

OP109: Osteoplastic surgery of the face in patients with oral cancer

Microsurgical reconstruction is mainly performed by revascularized osseous, osteocutaneous, or osteomyocutaneous distant flaps in acquired large oro-maxillo-facial defects since the early 1980s of the last century. To give consideration to the subtle special anatomy of the face and skull, prefabrication of complex composite grafts were introduced for reconstruction in 1996. At the same time orthopaedists established the distraction osteogenesis for restoration and rehabilitation of extremities defects which in succession soon afterwards was being modified for usage in craniofacial surgery. As initially pointed out by McCarthy, it has taken craniofacial surgeons out of the field of soft-tissue and hard-tissue construction and into that of tissue engineering and “inductive surgery.” (McCarthy et al., 1992). This paper reports the clinical application of both methods the distraction osteogenesis and microsurgical reconstruction, with prefabricated composite grafts, even in combination, to rehabilitate patients with oral cancer.

Use of biogenic and bioinert materials in osteoplastic surgery (a review of literature)

Ukrainian and foreign scientific sources, dealing with use of biogenic, bioinert materials and other components of tissue-engineering structures in osteoplastic surgery, are analytically reviewed. Classifications of osteoplastic materials and detailed information about variants of their influence on reparative regeneration of the bone tissue are presented, as well as the most promising directions of regenerative medicine are described. Despite a large number of designed implants and appearance of a new field, tissue engineering, at present there is not any single “gold standard” in treatment of bone tissue defects, each drug having its positive and negative properties. Hence, the positive clinical result can be achieved only in case of an adequate choice of an implant depending upon a concrete clinical situation and with strict observance of demands of technologies for its use.

Autotransplantation of immobilized stromal bone marrow cells during lumbar spondylosyndesis in an experiment

Aim. To assess the ability of immobilized autologous bone marrow stromal cells to provide an effective repair with the formation of a robust bone block in the area of the interbody defect of the spinal motor segment after total removal of the intervertebral disc. Methods. Studied were the effects of autotransplantation of different cell fractions isolated from the bone marrow (mononuclear, stromal cells and stromal stem cells) on the formation of the anterior bone block during interbody spondylosyndesis in an experiment on 24 mongrel dogs of different sexes (mean weight 18.3 kg, the mean diameter of the lumbar vertebral bodies according to radiographic study 18.6 mm). All animals underwent the crest puncture the right wing of the ilium, with aspiration of 10 ml of bone marrow, conducted was a total diskectomy at the level of the bodies of the VII and VIII lumbar vertebras with replacement of the interbody defect with a porous metal cylinder of the Nickel titanium of an appropriate shape and size. All animals were randomly divided into four groups, 6 in each. In the first group the interbody defect was filled with a porous metal cylinder only, in the second group - with the fraction of bone marrow mononuclear cells, in the third - with the fraction of stromal cells, in the fourth - with the fraction of culture-grown stromal cells. Results. In the first (control) group established were the signs of delayed formation of the anterior bone block, formation of the hypertrophic interbody pseudarthrosis. Noted was the formation of coarse fibrous capsule in the zone of «implant-bone» contact, an excess of cartilage tissue, the small size and low proliferative activity of osteoblasts, hypoplasia of the blood vessels. In the second group determined was the forming artificial bone block with paravertebral hyperostosis, radiologically - microdislocation of the implant with protrusion into the body of the adjacent vertebra and partial osteointegration with the porous structure of the fixer in the contact «implant-bone» zone. Bone formation occurred by the type of secondary osteogenesis with an excess of cartilage tissue. In the third and fourth groups formed was a robust artificial bone block, no signs of implant dislocation were observed. Determined was the full osteointegration of the porous structure of the fixer in the contact «implant-bone» zone. The newly formed bone tissue surrounded the implant in a muft-like fashion and grew into its porous structure, grew into the periosteal zone of adjacent vertebral bodies, well adhering with their surface. Conclusion. The proposed method of correction of osteoreparation disorders can be considered as an alternative to osteoplastic operations with the transplantation of massive bone grafts, as well as in conditions of systemic disorders of the ostepoetic function with a critical shortage of endogenous progenitors of bone cells.

Osteoplastic surgery of the face—state of the art and future aspects

Background The management of facial defects has rapidly changed in the last decade. Functional and esthetic requirements have steadily increased along with the refinements of surgery.

Osteoplastic surgery of the face – state of the art and future aspects

BACKGROUND: The management of facial defects has rapidly changed in the last decade. Functional and esthetic requirements have steadily increased along with the refinements of surgery. METHODS: To achieve excellence, a comprehensive spectrum of osteoplastic surgical methods, in particular in combination with each other, is required to meet this challenge. Osteomyocutaneous flaps, advanced block grafting techniques, especially complex prefabricated composite grafts, and distraction osteogenesis last being the most recent surgical method both in reconstructive and orthognathic face surgery, are in use. RESULTS: Since osseous deficiencies of any kind ranging from aging, malocclusion-related skeletal disfigurement to orofacial defects result in facial deformities and impairment of function, the goal of osteoplastic surgery is the reconstruction of the skeletal architecture to achieve an esthetic and functional musculoskeletal balance of the face. Exemplary are CLP and the complete clinical picture of facial aging. CONCLUSIONS: Against this background plastic-reconstructive face surgery, craniofacial surgery and oral implant surgery still exist in isolated clinical fields although an interdisciplinary approach on new surgical concepts would be able to shift the border of the possible considerably. Because of the complexity of the demonstrated osteoplastic proceedings, oral surgery and its used bone substituted materials will only be marginally reviewed.

Platon Ivanovich Tikhov, Professor of Surgery of the Imperial Tomsk University (to 145th anniversary)

The number of publications devoted to the development of medicine in Siberia is increasing in the last years, but still insufficient. In this paper, the authors tried to reconstruct the biography of Platon Ivanovich Tikhov, Professor of the Tomsk Imperial University, whose results enriched the Russian and international surgical science in the field of osteoplastic operations, surgery of abdominal cavity and parenchymal organs, blood vessels and heart, anaesthetization. P.I. Tikhov was the first in Siberia, who performed the heart wound closure operation (1907).

Erfahrungen bei der Verwendung resorbierbarer Osteosynthesematerialien

Different materials can be used for fixation of fractures or for osteoplastic operations in head and neck surgery. Especially metallic and resorbable implants are at the market now. Advantages and disadvantages of the different implants should be considered as decisive for different indications. We retrospectively analyzed the patients since 1999 which we operated using such resorbable materials. From 1999 until 2006 we used LactoSorb(®). 2007 we introduced the Resorb X(®) plates and -meshs and the SonicWeld Rx-System(®). Here the plates or meshs will be fixed by an ultrasonically welded pin. In 52 cases we implanted LactoSorb(®) and Resorb X(®) with the SonicWeld Rx-System(®). In 2 cases we saw a foreign body reaction that resulted in a fistula. In one case a plate broke after fixing. The use of resorbable materials with ultrasonically welded pin osteosynthesis resulted in a stable mechanical connection, an easy intraoperative handling and a low rate of complications. Those materials can be used for traumatologic and osteoplastic reconstructions in head and neck surgery.

テルダーミスを用いた骨形成性上顎洞手術

Osteoplastic maxillary antrostomy is performed to restore the normal anatomy and physiology of the maxillary sinus. Although endoscopic sinus surgery has been employed since the 1980s, antrostomy through the canine fossa is still required in cases such as an inverted papilloma originating from the maxillary sinus or a blow-out fracture of the inferior orbital floor. Herein, we demonstrate a new procedure using a collagen sponge (Terudermis®, Olympus Terumo Biomaterials Co., Ltd., Tokyo, Japan) to support the free bone flap of the anterior wall of the maxillary sinus. The collagen sponge also promotes epithelialization of the maxillary sinus. We employed this procedure in 11 cases, including five cases involving repair of a blow-out fracture of the inferior orbital floor, two to remove fungal growth from the maxillary sinus, three to remove an inverted papilloma of the maxillary sinus, and one for removal of an odontogenic maxillary cyst. In all cases, the maxillary sinus was epithelialized without infection, except for one recurrent case of papilloma. In seven of the 11 cases, postoperative CT was performed, showing that the bony flap was maintained in the original position. This new method simplifies osteoplastic maxillary surgery and reduces the surgical time.

Osteoplastic Thumb Ray Restoration with or without Secondary Toe Transfer for Reconstruction of Opposable Basic Hand Function

Mutilating hand injuries result in bone and soft-tissue defects. Osteocutaneous flaps can be used for osteoplastic thumb ray reconstruction as a definitive procedure or followed by toe transfer. Twenty-four hands with thumbs amputated proximal to the metacarpophalangeal joint underwent osteoplastic surgery for first ray bone and soft-tissue reconstruction. The Kapandji classification was used for the evaluation of basic hand function (opposable ulnar and radial components) after osteoplastic surgery and after toe transfer. Thirteen of 24 osteoplastic neothumbs (54 percent) achieved opposition; the other 11 patients underwent corrective osteotomies or toe transfer on the osteoplastic thumb rays. Five in this group achieved opposition, for an overall result of basic hand function in this series of 83.3 percent (20 of 24). Thirteen of 15 patients (86.7 percent) who had thumb amputations regained basic hand function only after osteoplastic thumb ray reconstruction, and 14 of 15 (93.3 percent) did so after revision. Six of nine patients (66.7 percent) with multiple-digit amputations regained opposition after osteoplastic thumb ray reconstruction and secondary revision. Ten patients received 12 toe flaps, two received sensate flaps, and one received an opponensplasty. Ten patients undergoing toe transfers had an average improvement of 4.1 on the Kapandji scale. Osteoplastic thumb ray reconstruction followed by osteotomies or sensate flap transfers can yield satisfactory results for some patients. Optimal functional outcomes are achieved when osteoplastic thumb ray reconstruction is followed by toe transfer.

Severe Traumatic Brain Injury in Austria V: CT findings and surgical management

The aim of this paper is to describe CT findings and surgical management of patients with severe traumatic brain injury (TBI) in Austria. Data sets from 415 patients treated by 5 Austrian hospitals were available. The analysis focused on incidence, surgical management, and outcome of different types of intracranial lesions, and outcome of surgical interventions with and without monitoring of intracranial pressure (ICP). For the first analysis we assigned the patients to 16 groups based on the type of lesion as evaluated by CT scan. For the second analysis we created 4 groups based on surgical treatment (yes/no) and ICP monitoring (yes/no). The mean age was 48.9 years with a male to female ratio of 299:116. The most frequent single lesions were contusions (CONT) and diffuse brain edema. Combined lesions were far more common than single lesions; the most frequently observed combinations included CONT and subarachnoid hemorrhage (SAH) with or without subdural hematoma (SDH). Surgery was done in 276 (66.5%) patients. Osteoplastic surgery (OPS; n = 221) was the most common method followed by osteoclastic surgery (OCS; n = 91) and decompressive craniectomy (DEC; n = 15). ICU mortality was 29.7% for all patients who had any kind of surgery, which was lower than that of patients who were treated non-operatively (33.1%). The ICU mortality of patients with SDH was lower with OCS (18.8%) than with OPS (36.0%). Patients who received ICP monitoring but did not require surgery had the lowest 90 day mortality (17.5%). ICP monitoring seems to be beneficial in both operatively and non-operatively treated patients with severe TBI. Patients with SDH who were operated on had significantly better outcomes. In patients with SDH, their outcome after osteoclastic surgery was significantly better than after osteoplastic procedures.

Rozwój koncepcji leczenia chirurgicznego zatok czołowych

The frontal sinus surgery has evolved over the past 120 years. There is an extensive literature focusing on this issue. The present review summarizes all major intranasal and external procedures in frontal sinus surgery. There were many techniques discovered and described in the literature; however, a single method that will lead to relief of clinical symptoms, complete eradication of disease with good functional outcome, minimal complications has not yet been attained. Frontoethmoidectomy alone has been the most frequently modified procedure by several authors. In mid-fifties of the last century the osteoplastic external surgery has emerged. Two decades later on new revolutionary endoscopic techniques have led to significant improvement in results of frontal sinus surgery. Endoscopic modified Lothrop procedure has become the most innovative method of frontal sinus surgery. Three dimensional computer assisted functional endoscopic sinus surgery and modern instrumentarium are among the latest techniques used nowadays, as they decrease the risk of complications and increase the precision and accuracy of surgical procedures.

Ossification of the frontal sinus in juvenile minipigs following water jet application

Obliteration of the frontal sinus is a generally accepted management for patients with severe craniofacial trauma in whom the sinus cannot be repaired or adequately drained. Effective obliteration requires complete removal of mucosa, sufficient filling of the sinus cavity as well as effective occlusion of the nasofrontal duct. The use of various filling materials for sinus obliteration has been described and include autologous fat, bone, muscle and lyophilized cartilage. In order to appreciate the advantages of the water-jet scalpel an animal study in 10 juvenile (4 months old) and 10 adult (18 months) minipigs was performed. In 5 juvenile and 5 adult animals the frontal sinus mucosa was removed using the water jet, while in the others bone curettes were used. No occlusion of the frontonasal duct was carried out and no filling material was implanted. All animals were followed-up for 40 days. After sacrifice, radiological, histological and computerized histomorphometrical examinations were carried out. Removal of the mucosa from the sinus was simplified when using the water jet. Previous studies have shown that the selected tissue structures were less traumatized when compared with conventional surgical techniques. In young animals (only) and exclusively following the use of a water-jet scalpel osseous occlusion of the frontal sinus was found at follow-up. Histomorphometric findings revealed a significant increase of bone formation in the frontal sinus area of these animals. Based on these experimental results in a small series of juvenile minipigs the water-jet technique is a faster and less traumatic technique (less blood loss) for osteoplastic surgery of the frontal sinus. Further long-term studies are needed to evaluate the possibilities for applying this technique in post-traumatic craniofacial surgery in man.

Jan Mikulicz‐Radecki (1850–1905): Pioneer of Endoscopy and Surgery of the Sinuses, Throat, and Digestive Tract

The authors described the medical achievements of Jan Antoni Mikulicz-Radecki--a famous surgeon and laryngologist of Polish origin, belonging to the Viennese surgical school of Prof. Theodor Billroth at the turn of the 20th century. His scientific and clinical activity in Vienna, Cracow, Konigsberg, and Wroclaw resulted in 232 publications and several new surgical methods. He changed the opinion on scleroma and described benign lymphoepithelial lesions. He was one of the authors of modern aseptics, antisepsis in surgery, and is regarded as a pioneer of endoscopic procedures. He was interested mainly in thoracic surgery, surgery of the abdomen, orthopedics, and laryngology. Mikulicz was the first to describe the method of surgical treatment of the maxillary sinus, osteoplastic surgery of the nose, esophagoscopy, and lateral pharyngotomy in tonsil carcinoma. Prof. Mikulicz was the first to perform thoracic surgery; he performed the first pyloroplasty, the first partial esophagectomy and gave rise to antiseptic procedures and general surgical management. He described many modifications of surgical operations and he constructed the esophagoscope, scoliozymeter, and many other useful surgical devices.

Patterns of Maxillary Alveolar Arch Growth Changes of Infants With Unilateral Cleft Lip and Palate: Preliminary Findings

Abstract Objective: Because of significant differences in pathomorphology at birth, it may be that a better treatment outcome prognosis exists for patients with incomplete versus complete cleft forms. Can reaction patterns be extracted from changes in maxillary dimensions of different cleft forms within the first year of life to support this hypothesis? Subjects: Chronologically consecutive casts of the maxilla (1 week and 3, 6, and 12 months of life) of 15 patients with complete unilateral cleft lip and palate (cUCLP) and 13 patients with incomplete unilateral cleft lip and palate (iUCLP). All patients were treated with passive palatal plates. Cheiloplasty was performed at 6 months of age. No primary osteoplastic surgery was carried out. Interventions: Following digitizing with a three-dimensional laser scanner, all cast surfaces were computer reconstructed, aligned, and superimposed. Distances between the surfaces were determined and expressed graphically. Computer-aided determination of defined maxilla...