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Wang P, Chen Q, Wang B, Wang Y, Zhang Q, Luo P. Bilateral Costal Cartilage Harvest for Auricle Reconstruction: A New Technique to Prevent Postoperative Thoracic Deformity. Laryngoscope 2024. [PMID: 38421050 DOI: 10.1002/lary.31350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/06/2024] [Accepted: 01/30/2024] [Indexed: 03/02/2024]
Abstract
HYPOTHESIS Unilateral costal cartilage harvesting (UCCH) for auricle reconstruction in children tends to cause thoracic deformities. Therefore, our study aimed to develop a novel bilateral costal cartilage harvesting (BCCH) method to prevent and reduce thoracic deformities. METHODS Patients with unilateral microtia who underwent either UCCH (n = 50) or BCCH (n = 46) were enrolled in this study. The grafts for the BCCH group were harvested from the 6th costal cartilage of the ipsilateral hemithorax and the 7th and 8th cartilage from the other hemithorax. Computed tomography and physical examination were performed to identify any physical deformities in the chest contours post-surgery. The cosmetic appearance of the thoracic scars post-surgery was evaluated using the Scar Cosmesis Assessment and Rating Scale (SCAR) and Visual Analogue Scales (VAS cosmetic). The numerical rating scale (NRS) was used to quantify the pain in donor sites. The reconstructed ears were assessed during the follow-up period. RESULT None of the patients in the BCCH group developed thoracic deformities, while 16 patients within the UCCH group developed mild (n = 12) or severe (n = 4) thoracic deformities (p < 0.001). The SCAR (3.09 vs. 2.92, p = 0.580) and VAS scores (0.96 vs. 0.90, p = 0.813) did not differ significantly between the two groups. For both treatment arms, the NRS scores were highest on the first-day post-surgery and gradually dropped over the 10 days. No significant differences were found in the NRS scores and the aesthetic outcomes of the reconstructed ears between the two groups. CONCLUSION The BCCH method effectively reduced the incidence of thoracic deformity at the donor site without increasing postoperative pain and cosmetic concerns for patients. It could be used clinically to improve patient outcomes of costal cartilage grafts. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Peizhou Wang
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Chen
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bingqing Wang
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Wang
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qingguo Zhang
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pan Luo
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Fermi M, Serafini E, Rosti A, Olive M, Alicandri-Ciufelli M, Sciarretta V, Fernandez IJ, Presutti L. Multilayer Anterior Skull Base Reconstruction with Cortical Rib Bone Graft: Preliminary Experience. World Neurosurg 2023; 179:e110-e118. [PMID: 37574191 DOI: 10.1016/j.wneu.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE During the past decades, different methods have been described for anterior skull base reconstruction. Regarding larger skull base defects, few investigators have described the use of bone grafts to foster support and prevent frontal lobe sagging, herniation, or falling. The aim of this study is to describe the use of a rib bone graft, which could be an option in these cases due to its rigidity and dimensions. METHODS We retrospectively collected preoperative, intraoperative, and postoperative data at the last follow-up of 10 patients who underwent multilayer anterior skull base reconstruction, including rib bone graft, for large anterior cranial base defects at 2 tertiary care academic hospitals. RESULTS Eight patients underwent endoscopic craniectomy for sinonasal malignancies, and the other two underwent transnasal endoscopic surgery for congenital meningoencephalocele. Anterior skull base defects measured on average 3.8 cm ± 0.9 SD antero-posteriorly (range 2.5-5 cm) and 2.3 ± 0.9 SD latero-laterally (range 0.9-4 cm). Multilayer reconstruction was performed in all cases, including a rib bone graft positioned as intracranial extradural layer. No patient experienced thoracic complications during the postoperative period. No side effects related to the bone graft or meningoencephalocele occurrence were reported after a mean follow-up of 8.0 ± 6.3 months. CONCLUSIONS The use of a cortical rib bone graft could be a safe and effective option in skull base reconstruction when managing large defects after cancer removal.
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Affiliation(s)
- Matteo Fermi
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Edoardo Serafini
- Department of Otorhinolaryngology Head and Neck Surgery, Azienda Ospedaliero, Universitaria Policlinico di Modena, Modena, Italy.
| | - Alessandro Rosti
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Olive
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otorhinolaryngology Head and Neck Surgery, Azienda Ospedaliero, Universitaria Policlinico di Modena, Modena, Italy
| | - Vittorio Sciarretta
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ignacio Javier Fernandez
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Hammad M, Veyssiere A, Leclercq S, Patron V, Baugé C, Boumédiene K. Hypoxia Differentially Affects Chondrogenic Differentiation of Progenitor Cells from Different Origins. Int J Stem Cells 2023; 16:304-314. [PMID: 37105555 PMCID: PMC10465331 DOI: 10.15283/ijsc21242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 04/29/2023] Open
Abstract
Background and Objectives Ear cartilage malformations are commonly encountered problems in reconstructive surgery, since cartilage has low self-regenerating capacity. Malformations that impose psychological and social burden on one's life are currently treated using ear prosthesis, synthetic implants or autologous flaps from rib cartilage. These approaches are challenging because not only they request high surgical expertise, but also they lack flexibility and induce severe donor-site morbidity. Through the last decade, tissue engineering gained attention where it aims at regenerating human tissues or organs in order to restore normal functions. This technique consists of three main elements, cells, growth factors, and above all, a scaffold that supports cells and guides their behavior. Several studies have investigated different scaffolds prepared from both synthetic or natural materials and their effects on cellular differentiation and behavior. Methods and Results In this study, we investigated a natural scaffold (alginate) as tridimensional hydrogel seeded with progenitors from different origins such as bone marrow, perichondrium and dental pulp. In contact with the scaffold, these cells remained viable and were able to differentiate into chondrocytes when cultured in vitro. Quantitative and qualitative results show the presence of different chondrogenic markers as well as elastic ones for the purpose of ear cartilage, upon different culture conditions. Conclusions We confirmed that auricular perichondrial cells outperform other cells to produce chondrogenic tissue in normal oxygen levels and we report for the first time the effect of hypoxia on these cells. Our results provide updates for cartilage engineering for future clinical applications.
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Affiliation(s)
- Mira Hammad
- Normandy University, UNICAEN, EA 7451 BioConnecT, Caen, France
- Fédération Hospitalo Universitaire SURFACE, Amiens, Caen, France
| | - Alexis Veyssiere
- Normandy University, UNICAEN, EA 7451 BioConnecT, Caen, France
- Fédération Hospitalo Universitaire SURFACE, Amiens, Caen, France
- Service de chirurgie Maxillo-faciale, CHU de Caen, Caen, France
| | - Sylvain Leclercq
- Normandy University, UNICAEN, EA 7451 BioConnecT, Caen, France
- Clinique Saint Martin, Service de Chirurgie Orthopédique, Caen, France
| | - Vincent Patron
- Normandy University, UNICAEN, EA 7451 BioConnecT, Caen, France
- Service ORL et chirurgie cervico-faciale, CHU de Caen, Caen, France
| | - Catherine Baugé
- Normandy University, UNICAEN, EA 7451 BioConnecT, Caen, France
- Fédération Hospitalo Universitaire SURFACE, Amiens, Caen, France
| | - Karim Boumédiene
- Normandy University, UNICAEN, EA 7451 BioConnecT, Caen, France
- Fédération Hospitalo Universitaire SURFACE, Amiens, Caen, France
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Nasal Reconstruction Using Rib Grafting with Cold Light Source Technology. Aesthetic Plast Surg 2022; 46:2404-2412. [PMID: 35348826 DOI: 10.1007/s00266-022-02842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Although costal cartilage is a reliable source of cartilage for rhinoplasty and provides a strong scaffold for total nasal reconstruction, traditional collection techniques may cause complications at the donor site. In this paper, we report a simple and safe technique for harvesting full-length costal cartilage and its application in total nasal reconstruction. METHODS From May 2018 to December 2020, 24 patients with nasal defects, including 16 females and eight males, received nasal reconstruction in the Rhinoplasty and Repair Center of the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences. Clinical outcomes were evaluated during the postoperative stay at the hospital and at the 6-30-month follow-up. RESULTS The operative time of cartilage harvesting ranged from 30 to 60 min. The patients could walk freely one day after surgery. The average ± standard deviation of Visual Analog Scale scores for pain at the harvested site were 2.583 ± 0.717 (at rest) and 4.750 ± 0.794 (during coughing) 6 h after surgery. We observed no complications (e.g., pleural perforation, pneumothorax, or massive bleeding) due to rib grafts in any patients. During the 6-30 months of follow-up, all patients had complete healing of both donor and recipient sites. The surgical results were rated as satisfactory or good by the patients and surgeons. CONCLUSIONS This new cold light source-assisted costal cartilage harvest technique allows full-length costal cartilage to be obtained for total nasal reconstruction, with minimal donor site complications, short operation time, fast postoperative recovery, and high satisfaction among patients and surgeons. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Yoon KH, Yoo JD, Choi CH, Lee J, Lee JY, Kim SG, Park JY. Costal Chondrocyte-Derived Pellet-Type Autologous Chondrocyte Implantation versus Microfracture for Repair of Articular Cartilage Defects: A Prospective Randomized Trial. Cartilage 2021; 13:1092S-1104S. [PMID: 32476445 PMCID: PMC8808917 DOI: 10.1177/1947603520921448] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare the efficacy and safety of costal chondrocyte-derived pellet-type autologous chondrocyte implantation (CCP-ACI) with microfracture (MFx) for repair of articular cartilage defects of the knee. DESIGN Thirty subjects with an International Cartilage Repair Society (ICRS) grade 3 to 4 chondral defect (2-10 cm2 in area; ≤4 cm3 in volume) were randomized at a ratio of 2:1 (CCP-ACI:MFx). Twenty patients were allocated in the CCP-ACI group and 10 patients in the MFx group. CCP-ACI was performed by harvesting costal cartilage at least 4 weeks before surgery. Implantation was performed without any marrow stimulation. Efficacy and safety were assessed at weeks 8, 24, and 48 after surgery according to the magnetic resonance observation of cartilage repair tissue (MOCART) score and clinical outcomes. RESULTS MOCART scores improved from baseline to 24 and 48 weeks postoperatively in both treatment groups. The improvement in MOCART scores in the CCP-ACI group was significantly greater than that in the MFx group at 24 and 48 weeks (39.1 vs 21.8 and 43.0 vs 24.8, respectively). The proportions of complete defect repair and complete integration were significantly higher in the CCP-ACI group than the MFx group at 48 weeks. Improvement in Lysholm score and KOOS subscores, including Function (Sports and Recreational Activity) and knee-related quality of life was significantly greater in the CCP-ACI group than the MFx group at 48 weeks (35.4 vs 31.5, 35.7 vs 28.5, and 27.9 vs 11.6, respectively). CONCLUSION Treatment of cartilage defects with CCP-ACI yielded satisfactory cartilage tissue repair outcomes, with good structural integration with native cartilage tissue shown by magnetic resonance imaging at 24 and 48 weeks after surgery. LEVEL OF EVIDENCE Level 1: Randomized controlled study.
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Affiliation(s)
- Kyoung-Ho Yoon
- Department of Orthopaedic Surgery,
Kyung-Hee University Hospital, Seoul, Republic of Korea
| | - Jae Doo Yoo
- Department of Orthopaedic Surgery,
School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Chong-Hyuk Choi
- Department of Orthopaedic Surgery,
Yonsei University, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Jungsun Lee
- R&D Institute, Biosolution Co.,
Ltd., Seoul, Republic of Korea
| | - Jin-Yeon Lee
- R&D Institute, Biosolution Co.,
Ltd., Seoul, Republic of Korea
| | - Sang-Gyun Kim
- Department of Orthopaedic Surgery, Korea
University College of Medicine, Ansan Hospital, Ansan, Republic of Korea
| | - Jae-Young Park
- Department of Orthopaedic Surgery,
Kyung-Hee University Hospital, Seoul, Republic of Korea,Jae-Young Park, Department of Orthopaedics,
Kyung-Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447,
Republic of Korea.
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Sultana J, Rahman QB, Chowdhury EH, Juyena NS, Bashar MA. Management of cardiorespiratory function of rabbits by a customized chest drain: An experimental study. J Adv Vet Anim Res 2021; 8:138-145. [PMID: 33860024 PMCID: PMC8043342 DOI: 10.5455/javar.2021.h496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/15/2020] [Accepted: 12/24/2020] [Indexed: 11/10/2022] Open
Abstract
Objective: This study aimed to salvage the study population from the fatality that occurs due to iatrogenic injury to the thoracic cavity’s pleural membrane. Materials and Methods: An experimental study of temporomandibular joint arthroplasty with costochondral graft was carried out on 72 healthy ‘Oryctolagus cuniculus’ species of male rabbits. The rabbits were distributed into two age groups: growing (3–4 months) and adult (12–18 months). All the procedures were carried out under general anesthesia with xylazine hydrochloride and ketamine hydrochloride after calculating the doses, maintained by halothane and O2 inhalations. Out of 72 rabbits, 33 rabbits had accidental perforation of the pleural membrane observed that required a chest drain. Results: In this study, 21 (63.64%) rabbits received chest drain and salvaged. The rest of the rabbits (n = 12; 36.36%) that did not receive any chest drain and died. Most of the rabbits (n = 17; 81%) were under the growing group, weighing less than 2 kg and four (19%) were adult rabbits. Conclusion: This manual chest drain is life-saving for rabbits. It is a new addition to the advancement of thoracic surgery on animals. It is cost-effective and safe. The developed customized drainage system may make it easier to harvest the costochondral graft-related experiments.
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Affiliation(s)
- Jachmen Sultana
- Department of Oral and Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Quazi Billur Rahman
- Department of Oral and Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Emdadul Haque Chowdhury
- Department of Pathology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Nasrin Sultana Juyena
- Department of Surgery and Obstetrics, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md Abul Bashar
- Department of Paediatrics, Cumilla Medical College Hospital, Cumilla, Bangladesh
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Eravci FC, Ceylan A, Yilmaz M. Thermal Chondroplasty Technique for Costal Cartilage Harvesting and Contouring. J Craniofac Surg 2020; 31:843-846. [PMID: 31895865 DOI: 10.1097/scs.0000000000006093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Although costal cartilage autograft has versatile usage, harvesting the graft is an invasive procedure with potential risks for complications. Therefore, it is important to make every effort to minimize these risks. Moreover, sculpting costal cartilage to the desired shape is challenging and time-consuming because of the natural rigidity. This study aimed to evaluate cases of costal cartilage harvest in terms of the most important donor site complications and to present a novel, practical and inexpensive technique to overcome the challenges in costal cartilage harvesting and contouring. A retrospective review of patient records was made of 103 patients who underwent costal cartilage harvest by the senior author. Costal cartilage harvest was applied using either the thermal chondroplasty technique or the conventional technique on patients undergoing revision rhinoplasty surgery. The number of complications and operation times were compared between the 2 techniques.A cohort of 47 patients (30 males, 17 females; mean age 34.5 years [range, 28-48 years]) underwent costal cartilage harvest using the thermal chondroplasty technique and a cohort of 56 patients (31 males, 25 females; mean age 36 years [range, 28-52 years]) underwent costal cartilage harvest with the conventional technique. The mean operation time for the costal cartilage harvest decreased by 7.5 minutes and the total operation time decreased by 17 minutes with the use of the thermal chondroplasty technique compared to the conventional technique (P < 0.05). Complications of 2 pneumothorax and 1 hematoma developed in the conventional technique group, and no complications were seen in the thermal chondroplasty group. The results of this study suggest that the thermal chondroplasty technique is safer and time-saving compared to the conventional technique.
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Affiliation(s)
- Fakih Cihat Eravci
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital
| | - Alper Ceylan
- Department of Otorhinolaryngology, Gazi University School of Medicine, Ankara, Turkey
| | - Metin Yilmaz
- Department of Otorhinolaryngology, Gazi University School of Medicine, Ankara, Turkey
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Zhao R, Pan B, Lin H, Long Y, An Y, Ke Q. Application of Trans-Areola Approach for Costal Cartilage Harvest in Asian Rhinoplasty and Comparison with Traditional Approach on Donor-Site Morbidity. Aesthet Surg J 2020; 40:829-835. [PMID: 31960891 DOI: 10.1093/asj/sjaa012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The traditional approach of harvesting costal cartilage through a chest wall incision can result in significant donor-site morbidity and usually causes notable scars in Asian patients. This has become the main concern for Asian females seeking rhinoplasty with autologous costal cartilage. OBJECTIVES The aim of this study was to investigate the donor-site morbidity of the trans-areola approach for costal cartilage harvest in Asian rhinoplasty and to compare it with the traditional approach. METHODS Patients' records were reviewed to determine whether their rhinoplasties had been performed with either the trans-areola or the traditional approach to costal cartilage harvest. Donor-site morbidity was evaluated 1 year postoperatively via a visual analog scale and the Modified Vancouver Scar Scale. Long-term complications of the trans-areola group were assessed at least 6 months after surgery. RESULTS There were 26 females in the trans-areola group and 35 females in the traditional group; both groups were of similar age and body mass index range. Compared with the traditional group, the trans-areola group had a significantly longer surgery time and a higher pneumothorax rate (7.7% vs 2.9%) but a significantly better scar quality and a higher overall satisfaction. Long-term outcomes and complications of the trans-areola group included significant scars (2/26, 7.7%), concavity of the breast (1/26, 3.8%), and local chest pain/discomfort (1/26, 3.8%). CONCLUSIONS Compared with the traditional approach to harvesting costal cartilage in Asian rhinoplasty, patients who underwent the trans-areola approach had less overall donor-site morbidity and higher overall satisfaction. We recommend this technique to patients who meet the inclusion criteria as well as those seeking a better cosmetic outcome. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Runlei Zhao
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Bailin Pan
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Hengju Lin
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Yan Long
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Yang An
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Qingfang Ke
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Hubei, China
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Gao Y, Gao J, Li H, Du D, Jin D, Zheng M, Zhang C. Autologous costal chondral transplantation and costa-derived chondrocyte implantation: emerging surgical techniques. Ther Adv Musculoskelet Dis 2019; 11:1759720X19877131. [PMID: 31579403 PMCID: PMC6759717 DOI: 10.1177/1759720x19877131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/29/2019] [Indexed: 01/08/2023] Open
Abstract
It is a great challenge to cure symptomatic lesions and considerable defects of hyaline cartilage due to its complex structure and poor self-repair capacity. If left untreated, unmatured degeneration will cause significant complications. Surgical intervention to repair cartilage may prevent progressive joint degeneration. A series of surgical techniques, including biological augmentation, microfracture and bone marrow stimulation, autologous chondrocyte implantation (ACI), and allogenic and autogenic chondral/osteochondral transplantation, have been used for various indications. However, the limited repairing capacity and the potential pitfalls of these techniques cannot be ignored. Increasing evidence has shown promising outcomes from ACI and cartilage transplantation. Nevertheless, the morbidity of autologous donor sites and limited resource of allogeneic bone have considerably restricted the wide application of these surgical techniques. Costal cartilage, which preserves permanent chondrocytes and the natural osteochondral junction, is an ideal candidate for the restoration of cartilage defects. Several in vitro and in vivo studies have shown good performance of costal cartilage transplantation. Although costal cartilage is a classic donor in plastic and cosmetic surgery, it is rarely used in skeletal cartilage restoration. In this review, we introduce the fundamental properties of costal cartilage and summarize costa-derived chondrocyte implantation and costal chondral/osteochondral transplantation. We will also discuss the pitfalls and pearls of costal cartilage transplantation. Costal chondral/osteochondral transplantation and costa-based chondrocytotherapy might be up-and-coming surgical techniques for recalcitrant cartilage lesions.
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Affiliation(s)
| | - Junjie Gao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Centre for Orthopaedic Translational Research, University of Western Australia, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Hengyuan Li
- Department of Orthopaedics, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Dajiang Du
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Dongxu Jin
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Minghao Zheng
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Changqing Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China
- Institute of Microsurgery on Extremities, Shanghai 200233, China
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Özücer B, Dinç ME, Paltura C, Koçak I, Dizdar D, Çörtük O, Uysal Ö. Association of Autologous Costal Cartilage Harvesting Technique With Donor-Site Pain in Patients Undergoing Rhinoplasty. JAMA FACIAL PLAST SU 2019; 20:136-140. [PMID: 28975239 DOI: 10.1001/jamafacial.2017.1363] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Postoperative pain at the donor site is a common morbidity following autologous costal cartilage grafting. Objective To evaluate postoperative pain at the donor site after the use of a muscle-sparing costal cartilage harvesting technique compared with a muscle-cutting technique using electrocautery. Design, Setting, and Participants Designed as a controlled trial without randomization, this prospective, comparative cohort study was conducted between January 1, 2016, and March 31, 2017. Participants included 20 patients who underwent rhinoplasty for various cosmetic and functional complaints from January 1, 2016, to February 28, 2017. Of the 20 patients, 1 was excluded owing to an infection that developed on postoperative day (POD) 7. Patients were grouped by the rib harvesting technique used that was either a muscle-sparing technique (n = 11) or a muscle-cutting technique (n = 8). Skin incisions for both groups were carried out with a blade. Transection of muscle fascia and muscle fibers was performed with monopolar electrocautery in the muscle-cutting technique group. Blunt dissection with a hemostat was performed in the muscle-sparing technique group. All other surgical techniques were identical. Main Outcomes and Measures Postoperative pain was assessed with visual analog scale scores for resting pain and movement pain. Eight pain measurements were noted at the sixth postoperative hour and on PODs 1, 2, 3, 7, 15, 30, and 45. During the hospital stay, the postoperative need for analgesics was recorded daily as the number of analgesic infusion vials used. Results The 19 patients in the study included 11 women and 8 men whose mean age (SD) was 33.2 (10.3) years The mean (SD) visual pain analog scale scores for resting pain and movement pain were consistently higher in the muscle-cutting technique group than in the muscle-sparing technique group. This difference was statistically significant on PODs 2, 3, and 15 for resting pain and on PODs 2, 3, 7, 15, 30, and 45 for movement pain. The mean postoperative need for analgesic infusion vials during hospital stay was higher in the muscle-cutting technique group, and the difference was statistically significant on POD 2 (1.9 [0.6] vials vs 1.0 [0.9] vials; P = .02). Conclusions and Relevance Both resting and movement pain at the donor site was significantly reduced in the muscle-sparing technique group during the postoperative period, findings that align with anecdotal reports in the literature. Routine use of the muscle-sparing technique in autologous costal cartilage harvesting is recommended to reduce postoperative pain. Level of Evidence 2.
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Affiliation(s)
- Berke Özücer
- Department of Otorhinolaryngology, Gaziosmanpasa Taksim Research and Education Hospital, Istanbul, Turkey
| | - Mehmet Emre Dinç
- Department of Otorhinolaryngology, Gaziosmanpasa Taksim Research and Education Hospital, Istanbul, Turkey
| | - Ceki Paltura
- Department of Otorhinolaryngology, Gaziosmanpasa Taksim Research and Education Hospital, Istanbul, Turkey
| | - Ilker Koçak
- Department of Otolaryngology, Koc University Hospital, Istanbul, Turkey
| | - Denizhan Dizdar
- Medical Faculty, Department of Otorhinolaryngology, Istanbul Kemerburgaz University, Istanbul, Turkey
| | - Oguz Çörtük
- Department of Plastic and Reconstructive Surgery, Gaziosmanpasa Taksim Research and Education Hospital, Istanbul, Turkey
| | - Ömer Uysal
- Department of Biostatistics, Bezmiâlem Vakif University, Istanbul, Turkey
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Griffin M, Kalaskar D, Butler P. Argon plasma modified nanocomposite polyurethane scaffolds provide an alternative strategy for cartilage tissue engineering. J Nanobiotechnology 2019; 17:51. [PMID: 30954085 PMCID: PMC6451776 DOI: 10.1186/s12951-019-0477-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/13/2019] [Indexed: 02/01/2023] Open
Abstract
Background Children born with a small or absent ear undergo surgical reconstruction to create a suitable replacement using rib cartilage. To overcome the donor site morbidity and long-term pain of harvesting rib cartilage, synthetic materials can be a useful alternative. Medpor, is the currently used synthetic polyethylene material to replace missing facial cartilage but unfortunately it has high levels of surgical complications including infection and extrusion, making it an unsuitable replacement. New materials for facial cartilage reconstruction are required to improve the outcomes of surgical reconstruction. This study has developed a new nanomaterial with argon surface modification for auricular cartilage replacement to overcome the complications with Medpor. Results Polyurethanes nanocomposites scaffolds (PU) were modified with argon plasma surface modification (Ar) and compared to Medpor in vitro and in vivo. Ar scaffolds allowed for greater protein adsorption than Medpor and PU after 48 h (p < 0.05). Cell viability and DNA assays demonstrated over 14-days greater human dermal fibroblast adhesion and cell growth on Ar than PU and Medpor nanocomposites scaffolds (p < 0.05). Gene expression using RT-qPCR of collagen-I, fibronectin, elastin, and laminin was upregulated on Ar scaffolds compared to Medpor and PU after 14-days (p < 0.05). Medpor, unmodified polyurethane and plasma modified polyurethane scaffolds were subcutaneously implanted in the dorsum of mice for 12 weeks to assess tissue integration and angiogenesis. Subcutaneous implantation of Ar scaffolds in mice dorsum, demonstrated significantly greater tissue integration by H&E and Massons trichrome staining, as well as angiogenesis by CD31 vessel immunohistochemistry staining over 12-weeks (p < 0.05). Conclusions Argon modified polyurethane nanocomposite scaffolds support cell attachment and growth, tissue integration and angiogenesis and are a promising alternative for facial cartilage replacement. This study demonstrates polyurethane nanocomposite scaffolds with argon surface modification are a promising biomaterial for cartilage tissue engineering applications. Electronic supplementary material The online version of this article (10.1186/s12951-019-0477-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle Griffin
- Division of Surgery & Interventional Science, University College London (UCL), London, UK. .,Plastic and Reconstructive Surgery Department, NHS Foundation Trust Hospital, Royal Free London, Pond Street, London, UK. .,The Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, UK.
| | - Deepak Kalaskar
- Division of Surgery & Interventional Science, University College London (UCL), London, UK.,UCL Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, Stanmore, Middlesex, HA7 4LP, UK
| | - Peter Butler
- Division of Surgery & Interventional Science, University College London (UCL), London, UK.,Plastic and Reconstructive Surgery Department, NHS Foundation Trust Hospital, Royal Free London, Pond Street, London, UK.,The Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, UK
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Zhang Z, Liu R, Wang R, Tang J, Liu C, Chen X, Cen Y, Li Z. [Application of three-dimensional mechanical equilibrium concept in cartilage scaffold construction for total auricular reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:332-336. [PMID: 30874391 DOI: 10.7507/1002-1892.201807137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To summarize clinical experience and curative effect in applying three-dimensional mechanical equilibrium concept to cartilage scaffold construction in total auricular reconstruction. Methods Between June 2015 and June 2017, ninety-seven microtia patients (102 ears) were treated with total ear reconstruction by using tissue expanders. The patients included 43 males and 54 females and their age ranged from 7 to 45 years with an average of 14 years. There were 92 unilateral cases (45 in left side and 47 in right side) and 5 bilateral ones. There were 89 congenital cases and 8 secondary cases. According to microtia classification criteria, there were 21 cases of type Ⅱ, 67 cases of type Ⅲ, and 9 cases of type Ⅳ. Tissue expander was implanted in the first stage. In the second stage, autogenous cartilage was used to construct scaffolds which were covered by enlarged flap. According to the three-dimensional mechanical equilibrium concept, the stable ear scaffold was supported by the scaffolds base, the junction of helix and inferior crura of antihelix, and helix rim. The reconstructed ears were repaired in the third stage operation. Results All patients had undergone ear reconstruction successfully and all incisions healed well. No infection, subcutaneous effusion, or hemorrhage occurred after operation. All skin flaps, grafts, and ear scaffolds survived completely. All patients received 5- to 17-month follow-up time (mean, 11.3 months) and follow-up time was more than 12 months in 61 cases (64 ears). All reconstructed ears stood upright, and subunits structure and sensory localization of reconstructed ears were clear, and the position, shape, size, and height of bilateral ears were basically symmetrical. Mastoid region scar hyperplasia occurred in 3 patients, which was relieved by anti-scar drugs injection. No scaffolds exposure, absorption, or structural deformation occurred during follow-up period. Conclusion Application of three-dimensional mechanical equilibrium concept in cartilage scaffold construction can reduce the dosage of costal cartilage, obtain more stable scaffold, and acquire better aesthetic outcomes.
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Affiliation(s)
- Zhenyu Zhang
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Ruiqi Liu
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Ru Wang
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jun Tang
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Chuanqi Liu
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xinghan Chen
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Ying Cen
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Zhengyong Li
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Delgove A, Weigert R, Casoli V. Evaluation of donor site morbidity after medial triceps brachii free flap for lower limb reconstruction. Arch Orthop Trauma Surg 2017; 137:1659-1666. [PMID: 28887648 DOI: 10.1007/s00402-017-2780-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The medial head of the triceps brachii muscle (MTB)-free flap is an attractive solution to cover small-to-medium defects of the lower limb. This muscular head has no well-identified function, suggesting minimal impact of its removal on elbow mobility. The aim of this study was to evaluate the safety and reliability of the harvest procedure and the functional and cosmetic morbidity of this donor site. MATERIALS AND METHODS Twenty-four consecutive MTB-free flaps were performed for reconstructive surgery of the lower limb between 2011 and 2015. Patients and their records were retrospectively examined. Functional results were evaluated by assessing elbow extension strength using a dynamometer and with a QuickDASH questionnaire. Cosmetic results were assessed using the POSAS observer and patient scales. RESULTS Twenty-four patients were followed up postoperatively for an average of 33.9 [min 12-max 59] months. No major complication (in particular, no ulnar or radial nerve injury) occurred during harvest. No patient complained of elbow pain or reduction in strength. Elbow extension was complete in all patients and the mean strength was calculated at 89 [61.1-112.5] % of the opposite arm. The POSAS scale scored an average 8.6 [7-21] for the observer and 10 [7-26] for the patient. Cosmetic results using the POSAS scale were satisfactory in all patients. CONCLUSIONS Objective evaluation of patients who underwent an MTB-free flap for limb reconstruction shows no impact of the harvesting procedure on elbow extension. Patient satisfaction with the donor site was high. From this retrospective study, it appears that this surgery is safe, aesthetically acceptable, and has minimal impact on donor site elbow function.
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Affiliation(s)
- A Delgove
- Plastic Surgery and Burns Unit, University Hospital of Bordeaux, FX Michelet Center, Place Amelie Raba Leon, 33076, Bordeaux, France.
| | - R Weigert
- Plastic Surgery and Burns Unit, University Hospital of Bordeaux, FX Michelet Center, Place Amelie Raba Leon, 33076, Bordeaux, France
| | - V Casoli
- Plastic Surgery and Burns Unit, University Hospital of Bordeaux, FX Michelet Center, Place Amelie Raba Leon, 33076, Bordeaux, France
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Ho TVT, Sykes K, Kriet JD, Humphrey C. Cartilage Graft Donor Site Morbidity following Rhinoplasty and Nasal Reconstruction. Craniomaxillofac Trauma Reconstr 2017; 11:278-284. [PMID: 30574271 DOI: 10.1055/s-0037-1607065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/17/2017] [Indexed: 10/18/2022] Open
Abstract
Although surgical techniques for rhinoplasty and nasal reconstruction are well established, prospective research on postoperative morbidity remains limited. The aim of this pilot study was to assess costal and auricular cartilage donor site pain and morbidity in patients undergoing rhinoplasty and nasal reconstruction. In this prospective cohort study, we enrolled 55 patients undergoing nasal surgery that required costal or auricular cartilage harvest from February 2015 through May 2016. Each patient was given a symptom-specific patient survey that assessed general pain, nasal pain, graft donor site pain, graft donor site itching, color variation, skin stiffness and thickness, and graft donor site appearance at 1, 4, and 12 weeks after surgery. Our patient group was 55% female ( n = 30); the mean age was 47 years. Rib cartilage graft patients had significantly greater nasal pain than cartilage donor site pain. There was no significant difference in rib versus ear cartilage donor site pain. Nearly all patients reported that they were not at all concerned about their scar appearance or ear shape and appearance. No prior studies compare cartilage donor site morbidity in patients undergoing nasal surgery. Our findings challenge the conventional wisdom that utilizing auricular and costal cartilage results in high levels of donor site pain. Surgeons should have a low threshold to harvest rib or ear cartilage when it can improve surgical outcome.
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Affiliation(s)
- Thuy-Van Tina Ho
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas
| | - Kevin Sykes
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas
| | - J David Kriet
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas
| | - Clinton Humphrey
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas
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Sersar SI, Yassin I, Eldin Aly MS. Autologous Diced Cartilage in Nasal Septoplasty. World J Plast Surg 2016; 5:293-297. [PMID: 27853694 PMCID: PMC5109392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Diced rib cartilage is an acceptable option in severe nasal deformities. We present our preliminary experience in KAMC in nasal septoplasties using the autologous diced costal cartilage. This is a retrospective study of the 22 cases who needed the autologous diced costal cartilage in our centre in 4 years. All our patients needed autologous diced rib cartilages. Twelve were wrapped with temporalis fascia, eight needed rectus fascia and perichondrium was used in only 2 cases. The naso-frontal angle for the whole series decreased by a mean of 4.41° (p=0.008) for the group using the rectus fascia diced cartilage graft. From the aesthetic point of view, all cases were satisfied except 3 (13.6%); two in the group of diced cartilage temporalis fascia; group 1. From the functional breathing view, only 1 case was not satisfied. He was in group 1. Autologous rib cartilage was shown to be a good graft in nasal septoplasty especially if wrapped with rectus fascia.
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Affiliation(s)
- Sameh Ibrahim Sersar
- Mansoura University, Cardiothoracic Surgery Department, 35516, Mansoura, Egypt;,KAMC, Makkah, Saudi Arabia; ,Corresponding Author: Sameh Ibrahim Sersar, MD, MRCSIR; Mansoura University, Cardiothoracic Surgery Department, 35516, Mansoura, Egypt , Tel: +96-650-3523249, E-mail:
| | - Ibrahim Yassin
- Saud AlBabtain Cardiac Centre, Dammam and Tanta University Hospital, Egypt;
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Saidulaev VA, Yunusov AS, Mukhamedov IT. [The application of mastoidoplasty in repeated scanning operations on the ear]. Vestn Otorinolaringol 2016; 81:40-43. [PMID: 26977567 DOI: 10.17116/otorino201681140-43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of the present study was to evaluate the outcomes of mastoid obliteration with the use of the orthotopic bone tissue taken from the linea temporalis region. It was shown that this region is the optimal site at the temporal bone for the harvesting of the plastic bone material to be used in mastoidoplasty during secondary sanitizing surgical interventions on the patients with mastoid cavity problems after canal wall-down mastoidrctomy under conditions of the deficiency of the orthotopic bone tissue. The application of such tissue for the purpose of mastoid-obliteration surgery provides a number of advantages over other methods of mastoidoplasty, in the first place from the standpoint of tissue biocompatibility. Multispiral computed tomography (MSCT) of the temporal bones is a highly informative and non-invasive technique for the study and control of the patients' condition during the late postoperative period following a secondary sanitizing surgical intervention involving mastoidoplasty with the application of the orthotopic bone tissue.
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Affiliation(s)
- V A Saidulaev
- Research and Clinical Centre of Otorhinolaryngology, Russian Federal Medco-Biological Agency, Moscow, Russia, 125310
| | - A S Yunusov
- Astrakhan branch of the Research and Clinical Centre of Otorhinolaryngology, Russian Federal Medco-Biological Agency, Astrakhan, Russia, 414056
| | - I T Mukhamedov
- Astrakhan branch of the Research and Clinical Centre of Otorhinolaryngology, Russian Federal Medco-Biological Agency, Astrakhan, Russia, 414056
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