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Shah SR, Tatara AM, Lam J, Lu S, Scott DW, Bennett GN, van den Beucken JJJP, Jansen JA, Wong ME, Mikos AG. Polymer-Based Local Antibiotic Delivery for Prevention of Polymicrobial Infection in Contaminated Mandibular Implants. ACS Biomater Sci Eng 2016; 2:558-566. [DOI: 10.1021/acsbiomaterials.5b00545] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Sarita R. Shah
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
| | - Alexander M. Tatara
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
| | - Johnny Lam
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
| | - Steven Lu
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
| | - David W. Scott
- Department
of Statistics, Rice University, Houston, Texas 77251, United States
| | - George N. Bennett
- Department
of BioSciences, Rice University, Houston, Texas 77005, United States
| | | | - John A. Jansen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark E. Wong
- University of Texas Health Science Center at Houston, Houston, Texas 77030, United States
| | - Antonios G. Mikos
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
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Zheutlin AR, Deshpande SS, Nelson NS, Polyatskaya Y, Rodriguez JJ, Donneys A, Buchman SR. A Histomorphometric Analysis of Radiation Damage in an Isogenic Murine Model of Distraction Osteogenesis. J Oral Maxillofac Surg 2015; 73:2419-28. [PMID: 26341682 DOI: 10.1016/j.joms.2015.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/31/2015] [Accepted: 08/01/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE The devastation radiation therapy (XRT) causes to endogenous tissue in patients with head and neck cancer can be a prohibitive obstacle in reconstruction of the mandible, demanding a better understanding of XRT-induced damage and options for reconstruction. This study investigated the cellular damage caused by radiation in an isogenic murine model of mandibular distraction osteogenesis (DO). The authors posited that radiation would result in fewer osteocytes, with increased empty lacunae and immature osteoid. MATERIALS AND METHODS Twenty Lewis rats were randomly assigned to a DO group (n = 10) or a XRT/DO group (n = 10). These groups underwent an osteotomy and mandibular DO across a 5.1-mm gap. XRT was administered to the XRT/DO group at a fractionated human equivalent dose of 35 Gy before surgery. Animals were sacrificed on postoperative day 40 and mandibles were harvested and sectioned for histologic analysis. RESULTS Bone that underwent radiation showed a significantly decreased osteocyte count and complementary increase in empty lacunae compared with non-XRT bone (P = .019 and P = .000). In addition, XRT bone exhibited increased immature osteoid and decreased mature woven bone compared with nonradiated bone (P = .001 and P = .003, respectively). Furthermore, analysis of the ratio of immature osteoid to woven bone volume exhibited a significant increase in the XRT bone, further showing the devastating damage from XRT (P = .001). CONCLUSION These results clearly show the cellular diminution that occurs as a result of radiation. This foundational study provides the groundwork on which to investigate cellular therapies in an immuno-privileged model of mandibular DO.
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Affiliation(s)
- Alexander R Zheutlin
- Medical Student, Craniofacial Research Laboratory, Plastic Surgery Section, University of Michigan, Ann Arbor, MI
| | - Sagar S Deshpande
- Medical Student, Craniofacial Research Laboratory, Plastic Surgery Section, University of Michigan, Ann Arbor, MI
| | - Noah S Nelson
- Research Fellow, Craniofacial Research Laboratory, Plastic Surgery Section, University of Michigan, Ann Arbor, MI
| | - Yekaterina Polyatskaya
- Resident, Craniofacial Research Laboratory, Plastic Surgery Section, University of Michigan, Ann Arbor, MI
| | - Jose J Rodriguez
- Research Fellow, Craniofacial Research Laboratory, Plastic Surgery Section, University of Michigan, Ann Arbor, MI
| | - Alexis Donneys
- Research Fellow, Craniofacial Research Laboratory, Plastic Surgery Section, University of Michigan, Ann Arbor, MI
| | - Steven R Buchman
- Professor in Plastic Surgery, Craniofacial Research Laboratory, Plastic Surgery Section, University of Michigan, Ann Arbor, MI.
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Does a change in bone mineral density occur in the mandible of Göttingen minipigs after irradiation in correlation with radiation dose and implant surgery? J Oral Maxillofac Surg 2014; 72:2149-56. [PMID: 25438274 DOI: 10.1016/j.joms.2014.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/22/2014] [Accepted: 05/22/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE To date, studies have not agreed on the effects of irradiation on bone mineral density. The aim of our study was to investigate the changes in mandibular bone mineral density after irradiation at various doses with and without surgery. MATERIALS AND METHODS We implemented a descriptive animal experiment. The sample included 16 female Göttingen Minipigs, randomly assigned to 4 groups and irradiated with equivalent doses of 0, 25, 50, and 70 Gy to the mandibular region. At 3 months after irradiation, the mandibular left premolars and molars were removed, and dental implants were placed. Computed tomography scans were taken before and 6 months after irradiation. The measured bone density was related to a bone phantom to calculate the bone mineral density quotient (BMDQ). The outcome variable was the BMDQ. Other study variables were the radiation dose and surgery. Descriptive and univariate analyses were computed, and significance was set at P ≤ .05. RESULTS In the left hemimandible, compared with the control group, a significant decrease in BMDQ was observed: 0.01 at 0 Gy, -0.01 at 25 Gy, -0.06 at 50 Gy, and -0.11 at 70 Gy (P = .023). The right hemimandible compared with the control group also showed a significant decrease in BMDQ: -0.02 at 0 Gy, -0.08 at 25 Gy, -0.09 at 50 Gy, and -0.11 at 70 Gy (P = .007). CONCLUSIONS The present study used a large animal model to simulate the tissue reactions induced by various radiation doses in the mandible. We found a significant decrease in the BMDQ after irradiation, but no significant correlation could be found between the irradiation dose and a decrease in the BMDQ.
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Yuhasz MM, Koch FP, Kwiatkowski A, Young C, Clune J, Travieso R, Wong K, Van Houten J, Steinbacher DM. Comparing calvarial transport distraction with and without radiation and fat grafting. J Craniomaxillofac Surg 2014; 42:1412-22. [PMID: 24864072 DOI: 10.1016/j.jcms.2014.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study is to: a) assess transport distraction to reconstruct cranial defects in radiated and non-radiated fields b) examine adipose grafting's effect on the bony regenerate and overlying wound, and c) elucidate sources of bone formation during transport distraction osteogenesis. Twenty-three male New Zealand white rabbits (3 months; 3.5 kg) were used, 10 non-irradiated and 13 irradiated (17 treatment, 6 control) with a one-time fraction of 35 Gy. A 16 × 16 mm defect was abutted by a 10 × 16 mm transport disc 5 weeks after irradiation, and 11 animals were fat grafted at the distraction site. Latency (1 day), distraction (1.5 mm/day), and consolidation (4 weeks) followed. Fluorochromes were injected subcutaneously and microCT, fluorescence, and histology assessed. In distracted animals without fat grafting, bone density measured 701.87 mgHA/ccm and 2271.95 mgHA/ccm in irradiated and non-irradiated animals. In distracted animals with fat grafting, bone density measured 703.23 mgHA/ccm and 2254.27 mgHA/ccm in irradiated and non-irradiated animals. Fluorescence revealed ossification emanating from the dura, periosteum, and transport segment with decreased formation in irradiated animals. Transport distraction is possible for cranial reconstruction in irradiated fields but short-term osseous fill is significantly diminished. Adipose grafting enhances wound healing in previously irradiated fields but does not enhance ossification.
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Affiliation(s)
- Mikell M Yuhasz
- Section of Plastic & Reconstructive Surgery, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - Felix P Koch
- Oral and Maxillofacial Surgery, University Medical Centre Mainz & Research Fellow Plastic Surgery, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - Anna Kwiatkowski
- Section of Plastic & Reconstructive Surgery, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - Calvin Young
- Section of Plastic & Reconstructive Surgery, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - James Clune
- Section of Plastic & Reconstructive Surgery, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - Rob Travieso
- Section of Plastic & Reconstructive Surgery, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - Kenneth Wong
- Section of Plastic & Reconstructive Surgery, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - Joshua Van Houten
- Yale Core Center for Musculoskeletal Disorders, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States
| | - Derek M Steinbacher
- Section of Plastic & Reconstructive Surgery, Director of Craniofacial Program, Yale School of Medicine, United States; Yale University School of Medicine, Department of Plastic and Reconstructive Surgery (John Persing, MD, Section Chief), 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT 06520, United States.
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Poort L, Lethaus B, Böckmann R, Buurman D, Jong JD, Hoebers F, Kessler P. Experimental Studies on the Irradiation of Facial Bones in Animals: A Review. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijohns.2014.33022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Allam KA, Lim AA, Elsherbiny A, Bradley JP, Kawamoto HK. Radiation-induced craniofacial deformities: A new classification and management algorithm. J Plast Reconstr Aesthet Surg 2013; 66:1088-95. [DOI: 10.1016/j.bjps.2013.04.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
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Deshpande SS, Monson LA, Cavaliere CM, Ayzengart AL, Buchman SR. Distraction osteogenesis following low-dose hyperfractionated irradiation in the rat mandible. J Oral Maxillofac Surg 2013; 71:1465-70. [PMID: 23866952 DOI: 10.1016/j.joms.2013.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 02/08/2013] [Accepted: 02/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The investigators hypothesized that low-dose hyperfractionated radiation would impair mandibular distraction osteogenesis (DO) in a murine mandibular model. MATERIALS AND METHODS Male Sprague-Dawley rats underwent fractionated radiation (30 Gy) of the left mandible. After a 2-week recovery period, an external frame distractor was applied and gradual distraction of the mandible was performed. Tissue was harvested after a 28-day consolidation period. Gross, radiologic, and histologic evaluations were undertaken. Control animals underwent surgery for an identical time frame without preoperative radiation. RESULTS Animals subjected to preoperative radiation (n = 10) showed suboptimal bone formation, including bone atrophy, incomplete bridging of the distraction gap, and gross bony defects or nonunion, compared with controls (n = 10). Although physical lengthening was achieved, irradiation consistently led to a detrimental effect on the normal process of DO. CONCLUSION This set of experiments establishes a valuable rodent model to evaluate the effects of radiation on DO and may help to formulate strategies to optimize DO before it is widely applied in oncologic reconstruction.
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Affiliation(s)
- Sagar S Deshpande
- Craniofacial Research Laboratory, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48104, USA.
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Stübinger S, Dard M. The rabbit as experimental model for research in implant dentistry and related tissue regeneration. J INVEST SURG 2013; 26:266-82. [PMID: 23617292 DOI: 10.3109/08941939.2013.778922] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The use of rabbits for experimental research has a long historical tradition. The aim of this review consists in outlining the use of the rabbit for research in implant dentistry and related tissue regeneration. Rabbits appear as a first-hand choice for fundamental implant design studies because of their size, easy handling, short life span, and economical aspects in purchasing and sustaining. In the following, the various anatomical sites in the rabbit will be summarized to provide an overview of current possibilities and limitations of this model for bone research in oral implantology.
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Affiliation(s)
- Stefan Stübinger
- Musculoskeletal Research Unit, University of Zurich , Zurich , Switzerland
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Monson LA, Cavaliere CM, Deshpande SS, Ayzengart AL, Buchman SR. The effects of high dose and highly fractionated radiation on distraction osteogenesis in the murine mandible. Radiat Oncol 2012; 7:151. [PMID: 22958832 PMCID: PMC3494577 DOI: 10.1186/1748-717x-7-151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 07/28/2012] [Indexed: 11/10/2022] Open
Abstract
The ability of irradiated tissue to support bony growth remains poorly defined, although there are anecdotal cases reported showing mixed results for the use of mandibular distraction osteogenesis after radiation for head and neck cancer. Many of these reports lack objective measures that would allow adequate analysis of outcomes or efficacy. The purpose of this experiment was to utilize a rat model of mandibular distraction osteogenesis after high dose and highly fractionated radiation therapy and to evaluate and quantify distracted bone formation under these conditions. Male Sprague–Dawley rats underwent 12 fractions of external beam radiation (48 Gray) of the left mandible. Following a two week recovery period, an external frame distractor was applied and gradual distraction of the mandible was performed. Tissue was harvested after a twenty-eight day consolidation period. Gross, radiologic and histological evaluations were undertaken. Those animals subjected to pre-operative radiation showed severe attenuation of bone formation including bone atrophy, incomplete bridging of the distraction gap, and gross bony defects or non-union. Although physical lengthening was achieved, the irradiated bone consistently demonstrated marked damaging effects on the normal process of distraction osteogenesis. This murine model has provided reliable evidence of the injurious effects of high dose radiation on bone repair and regeneration in distraction osteogenesis utilizing accurate and reproducible metrics. These results can now be used to assist in the development of therapies directed at mitigating the adverse consequences of radiation on the regeneration of bone and to optimize distraction osteogenesis so it can be successfully applied to post-oncologic reconstruction.
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Affiliation(s)
- Laura A Monson
- Craniofacial Research Laboratory, University of Michigan, 2228 BSRB, 109 Zina Pitcher, Ann Arbor 48109, USA
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Liu Y, Liu G, Xu J, Zhu G, Wang Z, Liu Y. Distraction osteogenesis in the dog mandible under 60-Gy irradiation. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:183-7. [PMID: 22677734 DOI: 10.1016/j.tripleo.2011.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 01/27/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study was to explore the probability of distraction osteogenesis (DO) in the irradiated dog mandible after 60-Gy irradiation. STUDY DESIGN Fourteen Chinese dogs were randomly divided into 2 groups. Twelve dogs received a preoperative unilateral irradiation from (60)Co (group R) in the mandible with a total dose of 24.8 Gy in four 6.2-Gy fractions (biologically equivalent to 60 Gy/25 fractions). The other 2 dogs without irradiation served as the control (group C). Bilateral corticotomies were made 6 months after completion of irradiation. Bone distraction was activated at a rate of 0.5 mm twice daily for 10 days after a 1-week latency period, followed by a consolidation phase of 8 weeks. The inferior alveolar nerve (IAN) underwent electrophysiologic analysis. Dog mandibles were subsequently subjected to histologic and radiographic analysis. RESULTS All the animals had successful distractions. After 8 weeks of consolidation, no difference was found between the percentage area of new bone in both groups. New bone was more mature and organized in group C than in group R. The action potential of IAN showed corresponding alternation during the irradiation and distraction process. CONCLUSIONS Based on this study it seems that DO may be feasible in dog mandible under 60-Gy irradiation. Further research is indicated.
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Affiliation(s)
- Yuxiao Liu
- Department of Oral and Maxillofacial Surgery, General Hospital of Jinan Military Region, Ji'nan, Shandong Province, China.
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Quantitative histomorphometric assessment of regenerate cellularity and bone quality in mandibular distraction osteogenesis after radiation therapy. J Craniofac Surg 2011; 21:1438-42. [PMID: 20818254 DOI: 10.1097/scs.0b013e3181ec693f] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The use of mandibular distraction osteogenesis (MDO) for tissue replacement after oncologic resection in head and neck cancer could have immense therapeutic ramifications. We have previously demonstrated significantly decreased mechanical and microdensitomeric metrics of our MDO regenerate after 36-Gy radiation. Quantitative histomorphometry, a third metric, would permit objective investigation of the effects of radiation on tissue and cellular composition. Our hypothesis is that radiation-induced cellular depletion and diminution in function impair optimal bone regeneration. METHODS Five rats received radiation to the left mandible; 5 received none. All animals underwent surgical placement of external fixators, creation of mandibular osteotomies, distraction to a 5.1-mm gap width, and consolidation. Point counting and color thresholding were performed. RESULTS There was a significant increase in empty lacunae and a corresponding diminution in osteocytes after radiation. Whereas the volume fraction of mineralized, mature bone was not different, that of nonmineralized, immature osteoid was significantly increased in the radiated group compared with that in the nonradiated group. CONCLUSIONS Our findings confirm our prior 2 metrics. Actually, all 3 diverse metrics--microdensitometry, biomechanical analysis, and histomorphometry--corroborate our hypothesis of cellular depletion and diminution of function as the potential mechanism of radiation-induced attenuation in the distracted regenerate. Furthermore, our findings of tissue and cellular changes in the irradiated regenerate elucidate the pathophysiology of decreased bone quality when amalgamated with our previous results. Therapeutic agents may now be introduced, and their effects on the irradiated regenerate critically measured, so that MDO may be used as a viable reconstructive option in patients with head and neck cancer.
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Alveolar Reconstruction by Distraction Osteogenesis Under Unfavorable Conditions. J Craniofac Surg 2010; 21:1810-2. [DOI: 10.1097/scs.0b013e3181f43e45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Takeuchi S, Matsuo A, Chiba H. Beneficial Role of Periosteum in Distraction Osteogenesis of Mandible: Its Preservation Prevents the External Bone Resorption. TOHOKU J EXP MED 2010; 220:67-75. [DOI: 10.1620/tjem.220.67] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Sawako Takeuchi
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University
| | - Akira Matsuo
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University
| | - Hiroshige Chiba
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University
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Alteration in volumetric bone mineralization density gradation patterns in mandibular distraction osteogenesis following radiation therapy. Plast Reconstr Surg 2009; 124:1237-1244. [PMID: 19935308 DOI: 10.1097/prs.0b013e3181b5a42f] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of mandibular distraction osteogenesis for tissue replacement after oncologic resection or for deformations secondary to radiotherapy could have immense therapeutic ramifications. Radiotherapy, however, drastically impairs bone healing, potentially precluding the use of mandibular distraction osteogenesis as a durable reconstructive option. The authors have previously demonstrated significantly decreased mechanical and histologic metrics of the mandibular distraction osteogenesis regenerate after 36 Gy. The authors' goal is to now investigate the effect of these same radiation dosages on bone densitometrics using micro-computed tomographic scanning. METHODS Six Sprague-Dawley rats received 36-Gy fractionated radiotherapy sessions to the left mandible; six received none. All animals had external fixators placed, creation of osteotomies, distraction, and consolidation. Mandibles were scanned with micro-computed tomographic scanning. Volumetric density and microdensitometric measurements were analyzed. RESULTS There was a significant difference in volumetric bone mineralization patterns in irradiated animals. Bone volume fraction and bone mineral density, however, demonstrated no significant differences. CONCLUSIONS The authors discovered a significant increase of low mineralized, immature bone and a significant decrease of highly mineralized, mature bone in the irradiated regenerate. These findings corroborate the authors' hypothesis that radiation induces a diminution in cell function, impairing optimal bone regeneration. Overall densitometrics, however, were unchanged according to micro-computed tomographic measurements, despite documented significant changes in biomechanical and histologic metrics. An optimal radiation dose must now be sought that demonstrates a higher degree of reproducible degradation, but not irreversible destruction, in all three outcomes. Such an approach will allow formulation of therapeutic interventions designed to enhance mandibular distraction osteogenesis so that it may be used as a viable reconstructive option.
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Liu Y, Liu G, Liu Y, Lin X. Character of distracted bone in irradiated canine mandibles and electrophysiological changes in the inferior alveolar nerve. Br J Oral Maxillofac Surg 2009; 48:115-20. [PMID: 19406538 DOI: 10.1016/j.bjoms.2009.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2009] [Indexed: 11/25/2022]
Abstract
Our aim was to explore the character of distracted bone in irradiated canine mandibles and the electrophysiological changes in the irradiated inferior alveolar nerve (IAN). Twelve Chinese dogs were studied, 10 of which were given unilateral irradiation of (60)Co in the mandible with a total dose of 22.8Gy in four 5.7Gy fractions (biologically equivalent to 50Gy/25 fractions) (experimental group). The other two dogs were not irradiated and served as controls. All had a bilateral corticotomy 3 months after irradiation. After a 1-week latency period distraction of the mandible was activated at a rate of 0.5mm twice daily for 10 days, followed by a consolidation phase of 8 weeks. New bone was assessed by radiographic, histological, and single-photon electron computed tomographic (SPECT) analysis. The IAN was analysed electrophysiologically. One dog in the experimental group was excluded from the study with anaesthetic problems. After 8 weeks of consolidation there was no difference between the percentage area of new bone in the two groups. New bone was more mature and organised in the control group than in the experimental group. SPECT analysis showed that there was active osteogenic activity in dogs in the experimental group. The action potential of the IAN showed corresponding changes during the irradiation and distraction processes. We conclude that distraction osteogenesis is feasible in previously irradiated canine mandibles and IAN.
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Affiliation(s)
- Yuxiao Liu
- Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, 145 West Changle Road, Xi'an, PR China
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Efficacy of Distraction Osteogenesis for Mandibular Reconstruction in Previously Irradiated Areas. J Craniofac Surg 2008; 19:1571-6. [DOI: 10.1097/scs.0b013e3181897351] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lopez-Heredia MA, Sohier J, Gaillard C, Quillard S, Dorget M, Layrolle P. Rapid prototyped porous titanium coated with calcium phosphate as a scaffold for bone tissue engineering. Biomaterials 2008; 29:2608-15. [DOI: 10.1016/j.biomaterials.2008.02.021] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 02/28/2008] [Indexed: 11/17/2022]
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Kashiwa K, Kobayashi S, Kimura H, Honda T, Nohara T, Fujiwara H, Hosoya Y, Arai Y. Reconstruction of a Severe Maxillofacial Deformity After Tumorectomy and Irradiation Using Distraction Osteogenesis and LeFort I Osteotomy Before Vascularized Bone Graft. J Craniofac Surg 2007; 18:1133-7. [PMID: 17912098 DOI: 10.1097/scs.0b013e318157280b] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We present the successful reconstruction of a large mandibular defect with a severe maxillofacial deformity after malignant tumor resection and irradiation. The patient was a 16-year-old boy with a defect in the left mandible, which extended from the mandibular body to the condylar process and hypoplasia of the maxillozygomatic complex on the left side as a result of ablation and radiotherapy of a grown rhabdomyosarcoma in the left infratemporal fossa at the age of 10. We planned a two-stage reconstruction because of his wide mandibular defect and hypoplasia. LeFort I type osteotomy to correct the maxillary declination was combined with mandibular lengthening to decrease the width of the defect in the first stage. New bone formation was confirmed at the distraction site 4 months after surgery, and the second stage was performed. A free latissimus dorsi myocutaneous flap with a vascularized scapula and rib was transferred to reconstruct the ramus of the mandible, zygomatic arch, and soft tissues. This procedure resulted in satisfactory results. In conclusion, the combination of distraction osteogenesis and microsurgical bone transplantation facilitated the straightforward reconstruction of a three-dimensional deformity with huge bony defects. We think that this combined surgical procedure will become a favorable option in the treatment of severe maxillomandibular deformities with bone defects.
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Affiliation(s)
- Katsuhiko Kashiwa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Iwate Medical University, Morioka, Japan.
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