Perichondrium Research Articles

Efficacy of endoscopic porcine small intestinal submucosa graft myringoplasty: a retrospective comparative study

Background The surgical outcomes following tympanic membrane (TM) repair are affected by many factors. Objectives To evaluate the efficacy of endoscopic porcine small intestine submucosa graft (PSISG) myringoplasty by comparing with endoscopic myringoplasty with temporal fascia (TF) and perichondrium (PC). Methods We conducted a retrospective comparative study that a total of 98 patients with TM perforations were included. The patients underwent endoscopic myringoplasty using PSISG, TF or PC as the graft. The closure rate, hearing outcomes, operative time and complications in three groups were compared. Results At 3 months postoperatively, the closure rate were 85.2% (23/27), 92.1% (35/38) and 87.9% (29/33) in the PSISG, TF and PC groups respectively (p = .667); Hearing improved after surgery in three groups (p < .001), and showed no significant difference among the three groups. The mean operative time of the PSISG group was shorter than autologous TF (p < .001) and PC groups (p < .001) in this study; No operative or postoperative complications were found among the three groups. Conclusion Compare to autologous temporal fascia or perichondrium, the PSISG appears to be an effective and safe material for TM perforations closure. Endoscopic PSISG myringoplasty may be an alternative technique for repairing TM perforations, especially for revision cases.

Autologous costal cartilage for nasal tip surgery: report of 86 cases

Objective To present our experience and techniques with the use of autologous costal cartilage grafts in Asian rhinoplasty, and to report the surgical results and complications in 86 consecutive rhinoplasty cases. Methods All operations were performed by the first author (Liu AT) with open approach, costal cartilages and perichondrium were used to reconstruct the nasal tip projection according to the tripod theory in rhinoplasty, after removing the previous injection material, L-shaped implant or hypertrophic scar tissue in the tip. Medical charts and operative records were reviewed retrospectively to summary the complications. Nasal dorsum augmentation was done by costal cartilage or I-shaped allograft, sometimes with anterior sheath of rectus abdominis. Patients＇ subjective satisfaction of the postoperative nasal appearance was self-evaluated with grading (1 worse, 2 no change, 3 improved, and 4 much improved). Results From September 2015 to March 2017, 86 patients underwent rhinoplasty at our hospital. The postoperative follow-up duration was 6 to 20 months. Overall, functional and aesthetic outcome was satisfactory in most patients, and the mean score by the patients＇ self-evaluation was 3.3±0.6. Graft exposure, mobility, or significant resorption, pneumothorax or significant donor-site pain were not observed. Conclusions Even with minimal complications and morbidities, autologous costal cartilage grafts in Asian rhinoplasty is a versatile and reliable graft material for nasal tip surgery in severe short or saddle nose, contracted nose due to previous L-shaped augmentation and revision rhinoplasty in which the septal cartilage has already been harvested. Key words: Autologous costal cartilage; Nasal tip plasty; Nasal dorsum augmentation; Revision rhinoplasty; Saddle nose

Application of costicartilage in rhinoplasty repair surgery

Objective To investigate the clinical application and effect of autogenous costal cartilage in rhinoplasty repair surgery. Methods From July 2015 to June 2018, 112 cosmetic patients were treated with costal cartilage nasal tip prosthesis in the Department of Cosmetic Surgery, Shanghai Yixing Medical and Beauty Hospital. By using the straight part of the ribs, the nasal columella was made with mortise groove and then septal expanded graft prepared by using two pieces of expanded grafts. The cap-like, shield-like cartilage and perichondrium were combined for completing nasal tip prosthesis. Results A total of 112 patients were treated after rhinoplasty repair surgery. After 6-24 months of follow-up, 100 (accounting for 89.3%) cosmetic seekers were satisfied with the shape of the nasal tip, 5 (accounting for 4.5%) of those patients were not being satisfied due to unexpected nasal tip point, 3 (accounting for 2.7%) surgical infection cases after rhinoplasty and underwent prosthesis removal, 2 (accounting for 1.8%) had slight deviation of nasal tip and 2 had partial necrosis of nasal septum mucosa. No pneumothorax or chest wall deformities were found. Conclusions Rib cartilage is an excellent material for nasal tip formation in rhinoplasty. The use of autogenous costal cartilage to repair aesthetic defects in the lower nose can achieve a more effective, safe and lasting effect. Key words: Costal cartilage; Transplantation, autologous; Rhinoplasty; Reconstructive surgical procedures; Mortise alveolar cartilage

Evaluation of different graft materials (Temporalis Fascia, Tragal Perichondrium, and Vein Graft) in Type 1 tympanoplasty

Aims and Objective: The present study was undertaken to compare the results of various autogenous tissues temporalis fascia, tragal perichondrium, and vein as graft materials for the Type 1 tympanoplasty. Materials and Methods: A total of 120 cases with large, subtotal, and total perforation were considered in the study. Of the 120 cases, temporalis fascia graft was used in 60 cases (Group-I), tragal perichondrium graft in 40 cases (Group-II), and vein graft in 20 cases (Group-III). The results were evaluated in the form of rate of graft success, hearing gain, and mean residual air-bone gap with respect to the graft materials. Results and Observation: A nonsignificant association was observed between the groups, that is, temporalis fascia (Group-I), tragal perichondrium (Group-II), and venous graft (Group-III), and the graft uptake (P = 0.96 > 0.05) and air-bone closure (χ2 = 2.908, P = 0.059 > 0.05). Conclusion: The graft take up rate and hearing improvement are similar for the different graft materials used. Size of the perforation does not significantly influence the success rate of tympanoplasty as per our study. Normal translucent appearance of neotympanum in the postoperative period was seen only with temporalis fascia and venous graft, while in tragal perichondrial, the neotympanum was whitish, thicker, and translucent to opaque.

A Rare Case of Pleomorphic Adenoma

Pleomorphic adenoma is a rare type of major salivary gland tumour that occurs in the nasal septum. We present the case of a 40-year-old woman with pleomorphic adenoma. A CT scan was performed and a well-defined soft tissue lesion at the left anterior nostril was found. An endonasal endoscopic excision of the mass was achieved. To reach the free margin of the mass, the perichondrium of the nasal septum was dissected. The post-operative course was uneventable.

Tissue engineering for articular cartilage repair: research status and prospect

The management of articular cartilage defects is one of the most challenging clinical problems for orthopaedic surgeons. Articular cartilage, a highly organized tissue with substantial durability, has a limited intrinsic healing capacity. Damage from trauma or degenerative pathology frequently results in gradual tissue deterioration, leading to debilitating joint pain, functional impairment and degenerative arthritis. At present, the common surgical treatments for articular cartilage injuries include microfracture, subchondral bone drilling, lavage and debridement and perichondral arthroplasty, autologous osteochondral transplantation, autologous chondrocyte implantation and autogenetic cancellous bone grafts. However, these techniques are not long-term clinical solutions, prompting the development of regenerative medicine and tissue engineering approaches to restore articular cartilage. Key words: Articular cartilage; Repair; Tissue engineering; Stem cells; Scaffolds

Surgical treatment of recurrent pseudocyst of auricle

To investigate the surgical techniques and skills for recurrent pseudocyst of auricle. Retrospective analysis of 20 cases from January 2006 to May 2014 in our department, who were treated by the operations with skills as follows, resection the anterior wall of pseudocyst cartilage and perichondrium, grooves cutting the roughing the posterior cartilages wall, and local compression. All 20 patients were followed up for 8 to 42 months and all were cured. No recurrence, infections and malformation were happened. Resection the anterior cartilage wall perichondrium of the pseudocyst, grooves cutting and roughing of posterior cartilages of the peudocyst, and in combined with local compression are effective treatment for recurrent cases.

Microscopic applied anatomy study of morphological structure of auricle

Objective To provide structure and function applied anatomical of auricle stabilizing system for plastic and reconstruction.Methods Twelve cases fresh ears from adult head specimen,to dissect the skin,muscle fascia system and cartilage,to observe nerve,blood vessel and structure of cartilage.Results The structure of auricle Including the perichondrium,auricle cartilage,muscle and ligament.There was a rich blood supply for auricle stabilize system.The mainly blood supply come from posterior auricular artery diameter was 1.2 ± 0.2 cm and superficial temporal artery diameter was 2.6 ± 0.3 mm.Vein accompanying with the same name.Lymphatic flow in the area of superficial muscle fascia.Conclusion The blood supply of posterior auricular artery and superficial temporal artery play a crucial role in auricle repair and reconstruction.The main structure of stable system was elastic cartilage.Auricle cartilage and muscle play an important role in the microsurgery of auricle cartilage morphology and location. Key words: Auricle; Cartilage; Applied anatomy; Microsurgery

Study on decellularized laryngeal scaffold in dogs

To explore the survivorship and character of decellularized laryngeal scaffold in pectoralis major muscle flap in canine. Eighteen donor larynx in experimental group were decellularized by perfusing sodium dodecyl sulphate. Three of them were used to detect the character of histology. The other fifteen ones were embedded in right pectoralis major muscle flap of acceptor canine. Donor larynx in control group were not perfused. Other experimental procedure was the same as experimental group. The specimens were harvested at two weeks, one month and two months after operation, respectively. Macroscopic view, histological examination and trypan blue staining were performed in the experimental group and control group. The size of the specimens decreased remarkably into disappearance in control group, there was statistical significance between the experimental group and the control group (which used least significant difference t test P < 0.05). There was only little neutrophils and lymphocytes infiltrating around the laryngeal scaffold at 2 weeks in the experimental group. One month after operation, loose connective tissue begin to form around the laryngeal scaffold. After two months of transplantation, the connective tissue became thicker and the number of blood vessels increased than before. There was a large number of lymphocytes and neutrophil infiltration around the laryngeal specimens in the control group at 2nd week. The perichondrium in the control group was damaged at one month post operation. The cartilage cells could not be detected two months after surgery. The survival rate of cartilage cell between experimental group (86.8% ± 3.2%) and the control group (88.6% ± 3.1%) did not show statistical significance before implantation (χ(2) = 0.19, P > 0.05). The survival rate of cartilage cell decreased insignificantly in experimental group while the survival rate declined obviously in the control group at two weeks and one month after operation, the difference had statistical significance (χ(2) were respectively 5.52 and 20.55, P were respectively < 0.05 and < 0.01), the survival rate of cartilage cell in experimental group was (65.8% ± 2.6%) at two months after operation, while the cartilage cell all disappeared in control group. Perfused decellularation technique can construct a low immunogenicity laryngeal cartilage scaffold which can survive in the chest muscle package and establish a good blood supplement. The decellularized laryngeal scaffold could be used as a biological scaffold for whole laryngeal reconstruction.

Multi-plane hyaluronic acid injection for rhinoplasty

To investigate the effect of multi-plane Hyaluronic acid (HA) injection for rhinoplasty. The HA was injected below or above the periosteum at the nasal bone, above the perichondrium at the cartilage portion of nose, and between the great alar cartilage at the nasal tip. The HA volume was 1-1.5 ml, according to the nose form and aesthetic assessment. Over-injection was not permitted. Touch-up injection could be performed one week after the first injection if need. From Jan. 2010 to Jan. 2012, 60 cases underwent rhinoplasty with HA injection. The patients were followed up for 10-13 months with satisfactory result. The effect lasted about 9 months with the longest period as 12 months and the shortest period as 6 months. Good results can be achieved with multi-plane HA injection for rhinoplasty.

Quantitative analysis of the ultrasonogram and histological findings in normal airway wall

To find out the correlation between endobronchial ultrasonography (EBUS) images and histologic findings in normal bronchial wall via quantitative analysis of the airway wall thickness and the layer thickness. From July 1st to December 31th in 2010, patients underwent lobectomy performed endobronchial ultrasonography (EBUS) before surgery and frost pathological examination after surgery. The layer thickness of EBUS and pathological images were measured. Bland-Altman plots were used to analyze the agreement between EBUS measurements and pathological measurements. Twenty-one patients were enrolled in the study. Five layers of the wall were distinguished at the ultrasonogram. Starting on the luminal side, the first, third and fifth layer (L1, L3, L5) were hyperechoic while the second, fourth layer (L2, L4) were hypoechoic. The wall thickness with good agreement was almost equal between the 2 kinds of images (1.877:1.745). L1 thickness was lager than the mucosa thickness (0.275:0.164). L2 thickness was smaller than the submucosa thickness (0.100:0.202). L1 + L2 thickness was almost equal to the thickness of mucosa and submucosa layer (0.375:0.366). The Bland-Altman plots showed poor agreement between the L1, L2 thickness and the mucosa thickness, the submucosa thickness while good agreement between the L1 + L2 thickness and the thickness of mucosa and submucosa layer. L3 thickness was lager than the inner perichondrium thickness (0.241:0.075), and L4 thickness was smaller than the cartilage layer thickness (0.655:0.811). L3 + L4 thickness was almost equal to thickness of the inner perichondrium and the cartilage layer (0.895:0.887). L5 thickness was almost equal to thickness of the outer perichondrium and the connective tissue outside the cartilage layer (0.533:0.491). The Bland-Altman plots showed poor agreement between the L3, L4 thickness and the inner perichondrium thickness, cartilage layer thickness, while good agreement between L5, L3 + L4, L3 + L4 + L5 thickness and the corresponding indexes. There is a five-layer structure on the bronchial EBUS image including the first layer at the luminal side corresponding to the mucosa and inner part of the submucosa; the second layer corresponding to the outer part of submucosal tissue; the third layer corresponding to the inner perichondrium and the inner part of the cartilage; the fourth layer corresponding to the outer part of cartilage; the fifth layer corresponding to the outer perichondrium and the connective tissue outside the cartilage layer.

Sternum-hyoid muscle transposition and arytenoid adduction for unilateral vocal cord paralysis

To explore the therapeutic effect of sternum-hyoid muscle transposition and arytenoid adduction for unilateral vocal cord paralysis (UVCP). Included in this study were 19 patients with UVCP lasted for 12 months to 15 years. The surgical technique was as follows. The thyroid cartilage was engaged with a skin hook and gently rotated anteriorly. The lateral-inferior corner of the thyroid cartilage was exposed and the muscular process of the arytenoid was identified. Then, the thyroid lamina on the involved side was parasagittally separated 5 mm off the midline. The inner perichondrium was carefully freed from the overlying thyroid cartilage. The lamina was retracted laterally, and a 3-0 prolene suture was placed through the muscular process and tied to the cricoid cartilage at the origin of the lateral cricoarytenoid muscle. A bipedicled strap muscle flap was then transposed into the space between the lamina and the inner perichondrium. Pre- and postoperative voice evaluations measured mean fundamental frequency, jitter, shimmer, harmonic ratio and maximal phonation time, as well as assessments of voice quality. Vocal improvement was obtained in 100% (19 of 19) of patients. Immediately after the operation, the ingression could be observed in vocal cord membrane and vocal process, vocal cord volume was amplified. There was a significant difference (P < 0.05) in all parameters (fundamental frequency, jitter, shimmer, harmonic ratio and maximal phonation time) between pre- and postoperative voice evaluations measured mean. There was no significant difference (P > 0.05) in voice evaluations measured mean between 2 months and 12 months after operation in all patients. No major complications were noted in any patient. Sternum-hyoid muscle transposition and arytenoid adduction for unilateral vocal cord paralysis is simple and convenient, no immune rejection, and the long-term result is stable.

An experimental study on reconstruction of the condyle of the temporomandibular joint using free autogenous costal perichondrial grafts in rabbits

The purpose of this study was to develop a new method to regenerate articular cartilage of the temporomandibular joint (TMJ) by transplantation of free autogenous costal perichondrium (PC). In the study, 50 adult rabbits received the operation. For the surgery in the test group, the rabbits were randomly matched in pairs within the group and underwent the surgery of cross transplantation of costal PC after trimming the articular surface of the condyle. Operations were carried out in the same way in the experimental group except for PC transplantation. Instead, the suture was stitched in stratified order in the control group. Examination methods included observation of sections under the microscope, observation of specimens under the electron microscope, proliferating cell nuclear antigen (PCNA) staining, and biochemical analysis of glucuronic acid (GA) content and collagen content. The results of different groups were compared with ANOVA. The transplanted homologous PC escaped observable immune repulsion so that it could survive to form new joint cartilage with approximately normal tissue structure and biochemical constitution. The reproduction process was similar to the normal one, but was prolonged a little. At the later stage, the degeneration and calcification in the basal layer increased. However, because of its limited scope, no apparent effect on cartilage growth and function was observed. Homologous xenografting of free costal PC will not result in an apparent immunorejection of the host. Instead, the grafts can maintain their existence by obtaining nutrition from surrounding tissues and regenerate cartilage tissue.

Differential gene expression in the perichondrium and cartilage of the neonatal mouse temporomandibular joint

Our goal was to discover genes differentially expressed in the perichondrium (PC) of the mandibular condylar cartilage (MCC) that might enhance regenerative medicine or orthopaedic therapies directed at the tissues of the temporomandibular joint. We used targeted gene arrays (osteogenesis, stem cell) to identify genes preferentially expressed in the PC and the cartilaginous (C) portions of the MCC in 2-day-old mice. Genes with higher expression in the PC sample related to growth factor ligand-receptor interactions [FGF-13 (6.4x), FGF-18 (4x), NCAM (2x); PGDF receptors, transforming growth factor (TGF)-beta and IGF-1], the Notch isoforms (especially Notch 3 and 4) and their ligands or structural proteins/proteoglycans [collagen XIV (21x), collagen XVIII (4x), decorin (2.5x)]. Genes with higher expression in the C sample consisted mostly of known cartilage-specific genes [aggrecan (11x), procollagens X (33x), XI (14x), IX (4.5x), Sox 9 (4.4x) and Indian hedgehog (6.7x)]. However, the functional or structural roles of several genes that were expressed at higher levels in the PC sample are unclear [myogenic factor (Myf) 9 (9x), tooth-related genes such as tuftelin (2.5x) and dentin sialophosphoprotein (1.6x), VEGF-B (2x) and its receptors (3-4x) and sclerostin (1.7x)]. FGF, Notch and TGF-beta signalling may be important regulators of MCC proliferation and differentiation; the relatively high expression of genes such as Myf6 and VEGF-B and its receptors suggests a degree of unsuspected plasticity in PC cells.

Stage-specific subsets of perichondrial osteoblasts differentially relate to endothelium and bone and display different destinations in development

Stage-specific subsets of perichondrial osteoblasts differentially relate to endothelium and bone and display different destinations in development

Perichondrial-mediated TGF-beta regulation of cartilage growth in avian long bone development

We previously observed using cultured tibiotarsal long-bone rudiments from which the perichondrium (PC) and periosteum (PO) was removed that the PC regulates cartilage growth by the secretion of soluble negative regulatory factors. This regulation is "precise" in that it compensates exactly for removal of the endogenous PC and is mediated through at least three independent mechanisms, one of which involves a response to TGF-beta. PC cell cultures treated with 2 ng/ml TGF-beta1 produced a conditioned medium which when added to PC/PO-free organ cultures effected precise regulation of cartilage growth. In the present study, we have investigated the possibility that TGF-beta itself might be the negative regulator which is produced by the PC cells in response to their treatment with TGF-beta1. Using a TGF-beta responsive reporter assay, we determined that PC cell cultures, when treated with 2 ng/ml or greater exogenous TGF-beta1, produce 300 pg/ml of active TGF-beta. Then we observed that this concentration (300 pg/ml) of active TGF-beta1, when added to PC/PO-free tibiotarsal organ cultures, effected precise regulation of cartilage growth, whereas concentrations of TGF-beta1 either greater or less than 300 pg/ml produced abnormally small cartilages. These results suggest that one mechanism by which the PC effects normal cartilage growth is through the production of a precisely regulated amount of TGF-beta which the PC produces in response to treatment with exogenous TGF-beta itself.

Expression patterns of βig-h3 in chondrocyte differentiation during endochondral ossification

betaig-h3 is a TGF-beta-induced extracellular matrix protein which is expressed in many tissues including bones and cartilages. In previous reports, we showed that betaig-h3 mediates cell adhesion and migration and, especially in bones, negatively regulates the mineralization in the end stage of endochondral ossification. Here, to elucidate the expression pattern and role of betaig-h3 in chondrocyte differentiation, ATDC5 chondrocytes and embryonic and postnatal mice were used for in vitro differentiation studies and in vivo studies, respectively. betaig-h3 was strongly induced by the treatment of TGF-beta1 and the expression level of betaig-h3 mRNA and protein were highly expressed in the early stages of differentiation but decreased in the late stages in ATDC5. Furthermore, the patterns of TGF-beta1, -beta2, and -beta3 mRNA expression were concurrent with betaig-h3 in ATDC5. betaig-h3 was deeply stained in perichondrium (PC), periosteum (PO), and prehypertrophic chondrocytes (PH) through the entire period of endochondral ossification in mice. betaig-h3 was mainly expressed in PC and PH at embryonic days and obviously in PH in postnatal days. These results suggest that betaig-h3 may play a critical role as a regulator of chondrogenic differentiation in endochondral ossification.

A Case of Repair Using Hydroxyapatite Cement for Recurrent Perilymphatic Fistulas Occurred at Round Window After Cholesteatoma Surgery

Perilymphatic fistula (PLF) is a rare condition characterized by abnormal leakage of perilymph from the inner ear into the middle ear via a defect in the oval or round windows. PLF needs special attention concerning early diagnosis and treatment, because it can cause dizziness, hearing loss, tinnitus, meningitis, and other symptoms. The diagnosis of PLF usually cannot be confirmed before exploratory tympanotomy. Fascia, perichondrium, loose areolar tissue, fat and gelfoam can be used effectively in the PLF repair. Fibrin glue was used to aid in securing the graft material. However, recurrence is not rare and revision is sometimes needed to relieve the symptoms associated with the leakage of perilymph. So otologic surgeons should keep in mind that PLF has a great tendency to recur. Careful surgical procedures together with strict postoperative management are important to prevent recurrence and hydroxyapatite cement (HAC) can be used to cover the fistula area as a alternative graft material in recurrent perilymphatic fistula. We report on one recurrent case of postoperative PLF occurring at the round window that was repaired with HAC.

Growth_induced strain determines the anisotropy in perichondrium

Growth_induced strain determines the anisotropy in perichondrium

Identification and characterization of a previously undetected region between the perichondrium and periosteum of the developing avian limb

In developing long bones, the growing cartilage and bone are surrounded by the fibrous perichondrium (PC) and periosteum (PO), respectively, which provide cells for the appositional growth (i.e., growth in diameter) of these tissues. Also during the longitudinal growth of a bone, the cartilage is continuously replaced by bony tissue, giving rise to the widely held assumption that the PC concomitantly gives rise to the PO. Except for this morphological correlate, however, no evidence exists for a direct conversion of PC cells to PO cells, and our observations presented here question this assumption. Instead, we have obtained evidence suggesting that a previously undescribed region exists between the PC and PO. This region, termed the border region (BR), has several unique characteristics which distinguish it from either the PC or PO, including (1) its lack of being determined to differentiate as either cartilage or bone, (2) its ability to preferentially elicit the invasion of blood vessels, and (3) its ability to undergo preferential growth.