Bone grafts in craniofacial surgery.
Ontology highlight
ABSTRACT:
SUBMITTER: Elsalanty ME
PROVIDER: S-EPMC3052656 | biostudies-other | 2009 Oct
REPOSITORIES: biostudies-other
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Project description:30 patients were operated upon using Surgibone (Bovine Xenograft) for purpose of providing osteogenic stimulation and mechanical support. Good to excellent results were obtained in 93% of cases highlighting the efficacy of this bone graft. Its use can hence circumvent the associated morbidity of bone graft harvest and yet perform as effectively as autologous bone graft. Its high cost, however, restricts its use to specialised centres and institutional practice.
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Project description:Introduction: Bone implant related infection is still one of the biggest challenges in bone and joint surgery. Antibiotic impregnated bone grafts seem to be promising in both treatment and prevention of these infections. However, great variance in methodology predominates this field of research. This paper gives an overview of the published literature. Methods: The PRISMA-flowchart was used as protocol for article selection. Medline was searched and articles were selected in accordance with predetermined exclusion criteria. Results: Forty-eight articles were included in the synthesis. Topics including bone graft type, manipulations of the graft, elution profile, bacterial inhibition, osteotoxicity, incorporation, special impregnation methods, clinical use and storage were investigated. Therapeutically, high initial levels seem appropriate for biofilm eradication. A single stage procedure in the treatment of bone implant related infection seems feasible. Prophylactically, the literature indicates a reduction of postoperative infections when using antibiotic impregnated bone grafts. Conclusion: Bone grafts are a suitable carrier for local antibiotic application both therapeutically and prophylactically.
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Project description:Achieving fusion in osseous procedures about the foot and ankle presents unique challenges to the surgeon. Many patients have comorbidities that reduce osseous healing rates, and the limited space and high weightbearing demand placed on fusion sites makes the choice of bone graft, bone graft substitute, or orthobiologic agent of utmost importance. In this review, we discuss the essential characteristics of grafts, including their osteoconductive, osteoinductive, osteogenic, and angiogenic properties. Autologous bone graft remains the gold standard and contains all these properties. However, the convenience and lack of donor site morbidity of synthetic bone grafts, allografts, and orthobiologics, including growth factors and allogenic stem cells, has led to these being used commonly as augments.Level of evidenceLevel V, expert opinion.
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Project description:Increasing evidence has demonstrated the important role of autophagy in skeletal homeostasis; however, the role of autophagy in craniofacial bone development and acquisition is largely unknown. In this study, we investigated the effect of autophagy suppression on craniofacial bone acquisition by deleting Fip200 or Atg5, two essential autophagy genes, using Osterix-Cre (Osx-Cre). We found that the Osx-Cre transgene mildly decreased the bone mass of parietal bone but not frontal bone, and did not affect cranial base bone mass in adult mice. In the cranial vault, Fip200 or Atg5 deletion similarly decreased 50% bone mass of neural crest-derived frontal bone; Atg5 deletion decreased 50% and Fip200 deletion decreased 30% bone mass of mesoderm-derived parietal bone. In the cranial base, Fip200 or Atg5 deletion similarly decreased 30% bone mass of neural crest-derived presphenoid bone; Atg5 deletion decreased 30% and Fip200 deletion decreased 16% bone mass of mesoderm-derive basioccipital bone. Lastly, we used doxycycline treatment to inhibit the Osx-Cre expression until 2 months of age and showed that postnatal Fip200 deletion led to cranial vault bone mass decrease in association with a small increase in both bone volume/tissue volume and tissue mineral density. Altogether, this study demonstrated the important role of autophagy in craniofacial bone acquisition during development and postnatal growth.
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Project description:We report our experience with the subcranial approach, developed at the Plastic Surgery Unit of Hospital "Ricardo Gutiérrez," for the treatment of injuries in the frontoethmoidal orbital region in pediatric patients. The subcranial approach was described by Raveh et al for the treatment of fractures in the frontoethmoidal area. The subcranial approach was used later for surgery of tumors and deformities of the frontoethmoidal region. We have used this approach in nine cases of nontraumatic injuries (one meningioma, one orbital bone fibrous dysplasia, one vascular malformation, five nasal dermoid cysts, and one fronto-orbital mucocele). One patient with vascular malformation died of a stroke 10 days after surgery. The patient with the meningioma had a recurrence. Another patient developed an infection that needed surgical resolution and hardware removal. A third patient suffered a mild infection that receded with medication. No other complications were registered. The surgical exposure obtained through this approach was always excellent and left no cosmetic defects. There was no evidence of facial growth disturbance in this group of patients, except in one patient who received radiotherapy after surgery. Operative time and hospitalization were lower in this group than in patients with conventional frontal craniotomy.
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Project description:The complex three-dimensional anatomy of the craniofacial skeleton creates a formidable challenge for surgical reconstruction. Advances in computer-aided design and computer-aided manufacturing technology have created increasing applications for virtual surgical planning in craniofacial surgery, such as preoperative planning, fabrication of cutting guides, and stereolithographic models and fabrication of custom implants. In this review, the authors describe current and evolving uses of virtual surgical planning in craniofacial surgery.
| S-EPMC4154978 | biostudies-other
Project description:ObjectivesThis study investigated the long-term surgical outcomes of functional cholesteatoma surgery with canal wall reconstruction using autologous bone grafts as the primary material in patients with acquired cholesteatoma.Subjects and methodsMedical charts were retrospectively reviewed for all patients admitted to one institution for surgical intervention between 2010 and 2018. We analyzed 66 patients (66 ears) who underwent functional tympanomastoidectomy involving the use of autologous bone grafts for canal wall defect reconstruction. Surgical outcomes were evaluated by comparing preoperative audiometric results with follow-up data (at least 36 months after surgery). Logistic regression analyses were performed to determine prognostic factors related to long-term hearing success. These factors included classification and stage of cholesteatoma, stapes condition, ossicular chain damage, active infection of the middle ear, state of the contralateral ear, preoperative hearing thresholds, gender, and age.ResultsThe mean follow-up period was 49.2 months. The recidivism rate was 6% (four of 66 ears). The pure-tone average significantly improved from 50.78 ± 19.98 to 40.81 ± 21.22 dB hearing level (HL; p < 0.001). Air-bone gaps significantly improved from 26.26 ± 10.53 to 17.58 ± 8.21 dB HL (p < 0.001). In multivariate logistic regression analysis, early-stage disease (p = 0.021) and pars flaccida cholesteatoma (p = 0.036) exhibited statistically significant correlations with successful hearing preservation.ConclusionFunctional cholesteatoma surgery with autologous bone grafts reconstruction is an effective approach to significantly improve hearing with low recidivism rates. Localized disease and pars flaccida cholesteatoma were two independent predictors of successful hearing preservation.
| S-EPMC8621709 | biostudies-literature
Project description:BackgroundOsteonecrosis of the femoral head was gradually concerned as a global disease for its progression to collapse of the femoral head, ultimately causing the arthritic change. Due to the high incidence of this disease in young people, arthroplasty tends to be suspected for its uncertain long-term efficiency. Vascularized pedicle iliac bone grafts, as a hip-preserving surgery, were regarded as an effective option in hip-preserving protocol since the 1970s. Nevertheless, there exist no unified standards widely agreed as the optimal operative program since the lack and heterogeneity of related studies. Thus, we execute this systematic review to synthesize and analyze existing studies, and further suggest a direction of future researches.MethodsData were collected by searching electronic database (PubMed, Embase, and Cochrane Library) and including the eligible studies of all types of clinical researches except case report. Through our extraction and synthesis of included study results in respect of clinical evaluation (rating scales), radiographic evaluation, joint survival rate, viability of implanted flap, and complications by transform varied assessment method into a unified standard, we qualitatively analyze and discuss the efficacy of VPIBG according to the quality of individual study and the heterogeneity across the included studies.ResultsOur systematic review includes 1 RCT, 2 case-control studies, and 13 case series studies, resulting in a significant improvement of postoperative scores. Minority of hips progressed for joint replacement. Some researches suggested a high collapse rate in the collapsed femoral head before the operation. Compared with some other hip-preserving surgeries, the complications of VPIBG are relatively slight and barely affect clinical efficiency.ConclusionsA better clinic response was obtained after this treatment, especially in femoral heads before the appearance of a crescent sign. The fixation of the implanted iliac bone flap increases the clinical effect. The majority of complications were slight and rarely affected clinical efficacy.
| S-EPMC6710879 | biostudies-literature
Project description:Reconstruction of complex craniofacial deformities is a clinical challenge in situations of injury, congenital defects or disease. The use of cell-based therapies represents one of the most advanced methods for enhancing the regenerative response for craniofacial wound healing. Both somatic and stem cells have been adopted in the treatment of complex osseous defects and advances have been made in finding the most adequate scaffold for the delivery of cell therapies in human regenerative medicine. As an example of such approaches for clinical application for craniofacial regeneration, Ixmyelocel-T or bone repair cells are a source of bone marrow derived stem and progenitor cells. They are produced through the use of single pass perfusion bioreactors for CD90+ mesenchymal stem cells and CD14+ monocyte/macrophage progenitor cells. The application of ixmyelocel-T has shown potential in the regeneration of muscular, vascular, nervous and osseous tissue. The purpose of this manuscript is to highlight cell therapies used to repair bony and soft tissue defects in the oral and craniofacial complex. The field at this point remains at an early stage, however this review will provide insights into the progress being made using cell therapies for eventual development into clinical practice.
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Project description:Bone grafts are used for the reconstruction of congenital and acquired deformities of the facial skeleton and, as such, comprise a vital component of the craniofacial surgeon's armamentarium. A thorough understanding of bone graft physiology and the factors that affect graft behavior is therefore essential in developing a more intelligent use of bone grafts in clinical practice. This article presents a review of the basic physiology of bone grafting along with a survey of pertinent concepts and current research. The factors responsible for bone graft survival are emphasized.
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