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Kirmanidou Y, Chatzinikolaidou M, Michalakis K, Tsouknidas A. Clinical translation of polycaprolactone-based tissue engineering scaffolds, fabricated via additive manufacturing: A review of their craniofacial applications. BIOMATERIALS ADVANCES 2024; 162:213902. [PMID: 38823255 DOI: 10.1016/j.bioadv.2024.213902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
The craniofacial region is characterized by its intricate bony anatomy and exposure to heightened functional forces presenting a unique challenge for reconstruction. Additive manufacturing has revolutionized the creation of customized scaffolds with interconnected pores and biomimetic microarchitecture, offering precise adaptation to various craniofacial defects. Within this domain, medical-grade poly(ε-caprolactone) (PCL) has been extensively used for the fabrication of 3D printed scaffolds, specifically tailored for bone regeneration. Its adoption for load-bearing applications was driven mainly by its mechanical properties, adjustable biodegradation rates, and high biocompatibility. The present review aims to consolidating current insights into the clinical translation of PCL-based constructs designed for bone regeneration. It encompasses recent advances in enhancing the mechanical properties and augmenting biodegradation rates of PCL and PCL-based composite scaffolds. Moreover, it delves into various strategies improving cell proliferation and the osteogenic potential of PCL-based materials. These strategies provide insight into the refinement of scaffold microarchitecture, composition, and surface treatments or coatings, that include certain bioactive molecules such as growth factors, proteins, and ceramic nanoparticles. The review critically examines published data on the clinical applications of PCL scaffolds in both extraoral and intraoral craniofacial reconstructions. These applications include cranioplasty, nasal and orbital floor reconstruction, maxillofacial reconstruction, and intraoral bone regeneration. Patient demographics, surgical procedures, follow-up periods, complications and failures are thoroughly discussed. Although results from extraoral applications in the craniofacial region are encouraging, intraoral applications present a high frequency of complications and related failures. Moving forward, future studies should prioritize refining the clinical performance, particularly in the domain of intraoral applications, and providing comprehensive data on the long-term outcomes of PCL-based scaffolds in bone regeneration. Future perspective and limitations regarding the transition of such constructs from bench to bedside are also discussed.
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Affiliation(s)
- Y Kirmanidou
- Laboratory for Biomaterials and Computational Mechanics, Department of Mechanical Engineering, University of Western Macedonia, University Campus ZEP, 50100 Kozani, Greece
| | - M Chatzinikolaidou
- Department of Materials Science and Engineering, University of Crete, 70013 Heraklion, Greece; Foundation for Research and Technology Hellas (FO.R.T.H), Institute of Electronic Structure and Laser (IESL), 70013 Heraklion, Greece
| | - K Michalakis
- Laboratory of Biomechanics, Department of Restorative Sciences & Biomaterials, Henry M. Goldman School of Dental Medicine, Boston University, Boston MA-02111, USA; Center for Multiscale and Translational Mechanobiology, Boston University, Boston, MA, USA
| | - A Tsouknidas
- Laboratory for Biomaterials and Computational Mechanics, Department of Mechanical Engineering, University of Western Macedonia, University Campus ZEP, 50100 Kozani, Greece; Laboratory of Biomechanics, Department of Restorative Sciences & Biomaterials, Henry M. Goldman School of Dental Medicine, Boston University, Boston MA-02111, USA.
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kIm H, Kim KH, Koh IC, Lee GH, Lim SY. Delayed treatment of traumatic eyeball dislocation into the maxillary sinus and treatment algorithm: a case report and literature review. Arch Craniofac Surg 2024; 25:31-37. [PMID: 38461826 PMCID: PMC10924793 DOI: 10.7181/acfs.2023.00535] [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: 10/19/2023] [Revised: 11/03/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Orbital floor fractures are commonly encountered, but the dislocation of the eyeball into the maxillary sinus is relatively rare. When it does occur, globe dislocation can have serious consequences, including vision loss, enucleation, and orbito-ocular deformity. Immediate surgical intervention is typically attempted when possible. However, severe comorbidities and poor general health can delay necessary surgery. In this report, we present the surgical outcomes of a 70-year-old woman who received delayed treatment for traumatic eyeball dislocation into the maxillary sinus due to a subarachnoid hemorrhage and hemopneumothorax. Additionally, we propose a treatment algorithm based on our clinical experience and a review of the literature.
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Affiliation(s)
- Hoon kIm
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, Konyang University of College of Medicine, Daejeon, Korea
| | - Keun Hyung Kim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, Konyang University of College of Medicine, Daejeon, Korea
| | - In Chang Koh
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, Konyang University of College of Medicine, Daejeon, Korea
| | - Ga Hyun Lee
- Department of Ophthalmology, Konyang University Hospital, Konyang University of College of Medicine, Daejeon, Korea
| | - Soo Yeon Lim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, Konyang University of College of Medicine, Daejeon, Korea
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Wu KY, Fujioka JK, Daigle P, Tran SD. The Use of Functional Biomaterials in Aesthetic and Functional Restoration in Orbital Surgery. J Funct Biomater 2024; 15:33. [PMID: 38391886 PMCID: PMC10889948 DOI: 10.3390/jfb15020033] [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: 12/24/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
The integration of functional biomaterials in oculoplastic and orbital surgery is a pivotal area where material science and clinical practice converge. This review, encompassing primary research from 2015 to 2023, delves into the use of biomaterials in two key areas: the reconstruction of orbital floor fractures and the development of implants and prostheses for anophthalmic sockets post-eye removal. The discussion begins with an analysis of orbital floor injuries, including their pathophysiology and treatment modalities. It is noted that titanium mesh remains the gold standard for orbital floor repair due to its effectiveness. The review then examines the array of materials used for orbital implants and prostheses, highlighting the dependence on surgeon preference and experience, as there are currently no definitive guidelines. While recent innovations in biomaterials show promise, the review underscores the need for more clinical data before these new materials can be widely adopted in clinical settings. The review advocates for an interdisciplinary approach in orbital surgery, emphasizing patient-centered care and the potential of biomaterials to significantly enhance patient outcomes.
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Affiliation(s)
- Kevin Y Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrook, QC J1G 2E8, Canada
| | - Jamie K Fujioka
- Faculty of Medicine, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Patrick Daigle
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrook, QC J1G 2E8, Canada
| | - Simon D Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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Kauke-Navarro M, Knoedler L, Knoedler S, Deniz C, Stucki L, Safi AF. Balancing beauty and science: a review of facial implant materials in craniofacial surgery. Front Surg 2024; 11:1348140. [PMID: 38327548 PMCID: PMC10847330 DOI: 10.3389/fsurg.2024.1348140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/05/2024] [Indexed: 02/09/2024] Open
Abstract
Facial reconstruction and augmentation, integral in facial plastic surgery, address defects related to trauma, tumors infections, and congenital skeletal deficiencies. Aesthetic considerations, including age-related facial changes, involve volume loss and diminished projection, often associated with predictable changes in the facial skeleton. Autologous, allogeneic, and alloplastic implants are used to address these concerns. Autologous materials such as bone, cartilage, and fat, while longstanding options, have limitations, including unpredictability and resorption rates. Alloplastic materials, including metals, polymers, and ceramics, offer alternatives. Metals like titanium are biocompatible and used primarily in fracture fixation. Polymers, such as silicone and polyethylene, are widely used, with silicone presenting migration, bony resorption, and visibility issues. Polyethylene, particularly porous polyethylene (MedPor), was reported to have one of the lowest infection rates while it becomes incorporated into the host. Polyether-ether-ketone (PEEK) exhibits mechanical strength and compatibility with imaging modalities, with custom PEEK implants providing stable results. Acrylic materials, like poly-methylmethacrylate (PMMA), offer strength and is thus mostly used in the case of cranioplasty. Bioceramics, notably hydroxyapatite (HaP), offer osteoconductive and inductive properties, and HaP granules demonstrate stable volume retention in facial aesthetic augmentation. Combining HaP with other materials, such as PLA, may enhance mechanical stability. 3D bioprinting with HaP-based bioinks presents a promising avenue for customizable and biocompatible implants. In conclusion, various materials have been used for craniofacial augmentation, but none have definitively demonstrated superiority. Larger randomized controlled trials are essential to evaluate short- and long-term complications comprehensively, potentially revolutionizing facial balancing surgery.
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Affiliation(s)
- Martin Kauke-Navarro
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
- Craniologicum, Center for Craniomaxillofacial Surgery, Bern, Switzerland
| | - Leonard Knoedler
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Samuel Knoedler
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Can Deniz
- Craniologicum, Center for Craniomaxillofacial Surgery, Bern, Switzerland
| | - Lars Stucki
- Faculty of Medicine and Dentistry, Danube Private University, Krems, Austria
| | - Ali-Farid Safi
- Craniologicum, Center for Craniomaxillofacial Surgery, Bern, Switzerland
- Medical Faculty, University of Bern, Bern, Switzerland
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Toh EMS, Thenpandiyan AA, Foo ASC, Zhang JJY, Lim MJR, Goh CP, Dinesh N, Vedicherla SV, Yang M, Teo K, Yeo TT, Nga VDW. Clinical Outcomes of 3D-Printed Bioresorbable Scaffolds for Bone Tissue Engineering-A Pilot Study on 126 Patients for Burrhole Covers in Subdural Hematoma. Biomedicines 2022; 10:0. [PMID: 36359222 PMCID: PMC9687313 DOI: 10.3390/biomedicines10112702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 10/29/2023] Open
Abstract
Burrhole craniostomy is commonly performed for subdural hematoma (SDH) evacuation, but residual scalp depressions are often cosmetically suboptimal for patients. OsteoplugTM, a bioresorbable polycaprolactone burrhole cover, was introduced by the National University Hospital, Singapore, in 2006 to cover these defects, allowing osseous integration and vascular ingrowth. However, the cosmetic and safety outcomes of OsteoplugTM-C-the latest (2017) iteration, with a chamfered hole for subdural drains-remain unexplored. Data were collected from a single institution from April 2017 to March 2021. Patient-reported aesthetic outcomes (Aesthetic Numeric Analog (ANA)) and quality of life (EQ-5D-3L including Visual Analog Scale (VAS)) were assessed via telephone interviews. Clinical outcomes included SDH recurrence, postoperative infections, and drain complications. OsteoplugTM-C patients had significantly higher satisfaction and quality of life compared to those without a burrhole cover (ANA: 9 [7, 9] vs. 7 [5, 8], p = 0.019; VAS: 85 [75, 90] vs. 70 [50, 80], p = 0.021), and the absence of a burrhole cover was associated with poorer aesthetic outcomes after multivariable adjustment (adjusted OR: 4.55, 95% CI: 1.09-22.68, p = 0.047). No significant differences in other clinical outcomes were observed between OsteoplugTM-C, OsteoplugTM, or no burrhole cover. Our pilot study supports OsteoplugTM-C and its material polycaprolactone as suitable adjuncts to burrhole craniostomy, improving cosmetic outcomes while achieving comparable safety outcomes.
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Affiliation(s)
- Emma M. S. Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.M.S.T.); (A.A.T.)
| | - Ashiley A. Thenpandiyan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.M.S.T.); (A.A.T.)
| | - Aaron S. C. Foo
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - John J. Y. Zhang
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Mervyn J. R. Lim
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Chun Peng Goh
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Nivedh Dinesh
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Srujana V. Vedicherla
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Ming Yang
- Division of Neurosurgery, Department of Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore;
| | - Kejia Teo
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Tseng Tsai Yeo
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Vincent D. W. Nga
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
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Shin JY, Lee NH, Kim MS, Roh SG, Chung YK. Limited eye movement caused by clumping of fibrin glue used in blowout fracture surgery: a care report. Arch Craniofac Surg 2022; 23:228-231. [DOI: 10.7181/acfs.2022.00829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/20/2022] [Indexed: 11/06/2022] Open
Abstract
Fibrin glue is a topical agent widely used for hemostasis, wound healing, and surgical adhesion. Complications of fibrin glue itself are extremely rare because it is absorbed over time, but can occur as a result of inappropriate application. We report a case of a postoperative complication caused by inappropriate application of fibrin glue in blow-out fracture surgery. A 65-year-old male patient presented with periorbital swelling and an open wound on the right infraorbital area. Computed tomography showed a right orbital floor fracture. After reduction of the herniated tissue into the orbit, an implant was inserted and fibrin glue was applied to stabilize the implant. This procedure was performed without difficulty, but the patient complained of persistent diplopia and limited eyeball movement after surgery. An imaging study showed a mass-like lesion, which was not a hematoma, in the orbital cavity. In a second operation, the mass was identified as clotted fibrin glue that had not been applied properly. After removal, the patient’s symptoms were relieved without further complications. Appropriate and careful application of fibrin glue is necessary to avoid unnecessary complications.
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Choi JH, Baek W. Late reconstruction of post-traumatic enophthalmos and hypoglobus using three-dimensional implants: a case series. Arch Craniofac Surg 2022; 23:232-236. [PMID: 36373258 PMCID: PMC9663267 DOI: 10.7181/acfs.2022.00850] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/19/2022] [Indexed: 01/25/2023] Open
Abstract
Post-traumatic enophthalmos and hypoglobus are common sequelae of facial bone fractures, even after reduction surgery. They are associated with functional and esthetic issues, which may lower the quality of life. These deformities frequently present late, and adequate correction is difficult. We report three cases of late inferior orbital rim reconstructions with three-dimensional printed implants to help resolve these problems. The average duration between the traumatic event and surgery was 3 years and 4 months. One patient was treated with a completely absorbable implant and exhibited satisfactory results until the implant started to biodegrade at 1 year and 9 months after surgery. Two patients were treated with a permanent implant and demonstrated satisfactory results. However, longer follow-up periods were needed. There were no complications such as infection, diplopia, or restriction of ocular motion and the patients were satisfied with the esthetic results.
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Affiliation(s)
- Jae Hyeok Choi
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Wooyeol Baek
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
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Ngo HX, Bai Y, Sha J, Ishizuka S, Toda E, Osako R, Kato A, Morioka R, Ramanathan M, Tatsumi H, Okui T, Kanno T. A Narrative Review of u-HA/PLLA, a Bioactive Resorbable Reconstruction Material: Applications in Oral and Maxillofacial Surgery. MATERIALS (BASEL, SWITZERLAND) 2021; 15:150. [PMID: 35009297 PMCID: PMC8746248 DOI: 10.3390/ma15010150] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/13/2022]
Abstract
The advent of bioresorbable materials to overcome limitations and replace traditional bone-reconstruction titanium-plate systems for bone fixation, thus achieving greater efficiency and safety in medical and dental applications, has ushered in a new era in biomaterial development. Because of its bioactive osteoconductive ability and biocompatibility, the forged composite of uncalcined/unsintered hydroxyapatite and poly L-lactic acid (u-HA/PLLA) has attracted considerable interest from researchers in bone tissue engineering, as well as from clinicians, particularly for applications in maxillofacial reconstructive surgery. Thus, various in vitro studies, in vivo studies, and clinical trials have been conducted to investigate the feasibility and weaknesses of this biomaterial in oral and maxillofacial surgery. Various technical improvements have been proposed to optimize its advantages and limit its disadvantages. This narrative review presents an up-to-date, comprehensive review of u-HA/PLLA, a bioactive osteoconductive and bioresorbable bone-reconstruction and -fixation material, in the context of oral and maxillofacial surgery, notably maxillofacial trauma, orthognathic surgery, and maxillofacial reconstruction. It simultaneously introduces new trends in the development of bioresorbable materials that could used in this field. Various studies have shown the superiority of u-HA/PLLA, a third-generation bioresorbable biomaterial with high mechanical strength, biocompatibility, and bioactive osteoconductivity, compared to other bioresorbable materials. Future developments may focus on controlling its bioactivity and biodegradation rate and enhancing its mechanical strength.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan; (H.X.N.); (Y.B.); (J.S.); (S.I.); (E.T.); (R.O.); (A.K.); (R.M.); (M.R.); (H.T.); (T.O.)
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Yoo H, Yoon T, Bae HS, Kang MS, Kim BJ. Does periosteum promote chondrogenesis? A comparison of free periosteal and perichondrial grafts in the regeneration of ear cartilage. Arch Craniofac Surg 2021; 22:260-267. [PMID: 34732038 PMCID: PMC8568495 DOI: 10.7181/acfs.2021.00423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background Elastic ear cartilage is a good source of tissue for support or augmentation in plastic and reconstructive surgery. However, the amount of ear cartilage is limited and excessive use of cartilage can cause deformation of the auricular framework. This animal study investigated the potential of periosteal chondrogenesis in an ear cartilage defect model. Methods Twelve New Zealand white rabbits were used in the present study. Four ear cartilage defects were created in both ears of each rabbit, between the central artery and marginal veins. The defects were covered with perichondrium (group 1), periosteum taken from the calvarium (group 2), or periosteum taken from the tibia (group 3). No coverage was performed in a control group (group 4). All animals were sacrificed 6 weeks later, and the ratio of neo-cartilage to defect size was measured. Results Significant chondrogenesis occurred only in group 1 (cartilage regeneration ratio: mean± standard deviation, 0.97± 0.60), whereas the cartilage regeneration ratio was substantially lower in group 2 (0.10± 0.11), group 3 (0.08± 0.09), and group 4 (0.08± 0.14) (p=0.004). Instead of chondrogenesis, osteogenesis was observed in the periosteal graft groups. No statistically significant differences were found in the amount of osteogenesis or chondrogenesis between groups 2 and 3. Group 4 showed fibrous tissue accumulation in the defect area. Conclusion Periosteal grafts showed weak chondrogenic potential in an ear cartilage defect model of rabbits; instead, they exhibited osteogenesis, irrespective of their embryological origin.
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Affiliation(s)
- Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea
| | - Taekeun Yoon
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea
| | | | | | - Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea
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