Prenatal cleft lip and maxillary alveolar defect repair in a 2-step fetal lamb model.

PURPOSE: As there is no satisfying animal model simulating the complex cleft lip and palate anatomy in a standardized defect on one hand, and comprising the possibilities for extensive surgical procedures on the other hand, an improved fetal lamb model for cleft surgery was developed. MATERIALS AND METHODS: Prior to the main study with 16 animals, a pilot study with 4 lambs was conducted. In the pilot study, the unilateral defect was induced at 75 days of gestation. Within 22 days the defect was repaired in 3 lambs; 1 lamb remained unoperated. Disappointing results from the pilot study led to an earlier defect induction (60 to 64 days of gestation) and earlier repair (71 to 84 days) in the main study with 16 lambs. The subsequent delayed repair of the defect was carried out using a Tennison-Randall technique in 10 lambs. In 4 lambs the defect was repaired postnatal, using the same technique. Two lambs had to be excluded from the study. After being euthanized, all animals were investigated macro- and microscopically. RESULTS: According to our criteria, the esthetic results ranged from satisfactory to good. Cutis and mucosa showed a full recovery whereas subcutis and the orbicularis oris muscle showed healing with scar formation. On average the operated lips were 9% shorter and were also thinner than the contralateral control side. CONCLUSIONS: In this study, the results of the closure of a standardized lip and maxillary alveolar defect in several stages of gestation were documented. Early intervention led to better esthetic results, but increased the risk of abortion by 25%. There was no prevention of scarring in subcutaneous and muscle tissue. Because there was no alignment of the orbicularis oris muscle, the goal of a functional perfect result was not achieved

Trans-sinusoidal maxillary distraction in three cleft patients.

Contains fulltext : 49821.pdf (publisher's version ) (Closed access)The trans-sinusoidal maxillary distractor (TS-MD) was used to achieve maxillary advancement in three patients with repaired cleft lip and palate. After preoperative computer-aided planning of the distraction vectors, each TS-MD was bent on a stereolithographic model of the maxilla of the patient. The devices were intraoperatively positioned using a methyl-methacrylate template. After standard Le Fort I osteotomy the devices were intraorally activated. After distraction the devices remained in situ for 3 months as rigid internal fixation of the maxilla. All patients were successfully distracted according to protocol. Maxillary advancement was 12, 8 and 11 mm. In two patients, additional maxillary widening of 6 and 8 mm was achieved by choosing divergent distraction vectors. After distraction a clockwise rotation of the maxilla was observed in two patients. There was no relapse during the 3 months of consolidation and 12-month follow-up. The TS-MD allows not only distraction but also rigid internal fixation after distraction. It was easy to apply but difficult to remove. Owing to preoperative 3D planning of the distraction vectors, the results were predictable, but clockwise rotation of the maxilla during distraction should be considered in planning. The distractor did not interfere with function or social activities during distraction and retention periods. After removal it left no extraoral scars

Surgical therapy in a patient with Keratosis-Ichthyosis-Deafness (KID) syndrome associated with follicular occlusion triad.

Contains fulltext : 53012.pdf (publisher's version ) (Closed access

[Hyperplasia of the coronoid process: diagnosis and treatment.]

Contains fulltext : 51249.pdf (publisher's version ) (Closed access

Hyperplasia of the coronoid process.

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Hyperplasia of the coronoid process in patients with ankylosing spondylitis (Bechterew disease).

Item does not contain fulltextAlthough involvement of the temporomandibular joint in patients with ankylosing spondylitis (AS, Bechterew disease) has been described previously, hyperplasia of the mandibular coronoid process in those patients has not been reported yet. Case notes were studied, and records were made of age, sex, clinical symptoms, radiography, and treatment in all patients with a confirmed diagnosis of coronoid hyperplasia presenting at the Department of Oral and Maxillofacial Surgery, University of Bonn, between 1995 and 2007. Sixteen cases of coronoid hyperplasia were recruited, of which 12 were bilateral and 4 were unilateral. Four patients had AS, 3 of them were HLA-B27-positive. Temporomandibular joint symptoms are frequently seen in patients with AS. Nevertheless, it must be considered that a limitation of jaw mobility in those patients might also be caused by an elongation of the mandibular coronoid process

Toll-like receptor 4 ligation enforces tolerogenic properties of oral mucosal Langerhans cells.

Item does not contain fulltextBACKGROUND: Despite high bacterial colonization, acute infections are rare in the oral mucosa, implicating tolerogenic predominance. Bacterial antigens like LPSs are recognized by innate immunity receptors such as Toll-like receptor 4 (TLR4), associated with LPS receptor (CD14). OBJECTIVES: Toll-like receptor 4 agonist monosphoryl lipid A has been successfully used as adjuvant in subcutaneous immunotherapy, suggesting reinforcement of allergen-specific tolerance. Recently sublingual immunotherapy (SLIT) has been shown to be an effective alternative to subcutaneous immunotherapy. We observed CD14 expression on human oral Langerhans cells (oLCs), representing a major target of SLIT. However, not much is known about TLR4 expression and its effect on oLCs. METHODS: Cell suspensions were obtained by trypsinization of human oral mucosa and analyzed by flow cytometry, RT-PCR, cytometric bead arrays, ELISA, and mixed lymphocyte reactions. RESULTS: We could show that oLCs express TLR4, and its ligation by monosphoryl lipid A upregulated expression of coinhibitory molecules B7-H1 and B7-H3 while surface expression of costimulatory molecule CD86 was concomitantly decreased. Furthermore, TLR4 ligation on oLCs increased their release of the anti-inflammatory cytokine IL-10 and decreased their stimulatory capacity toward T cells. Moreover, TLR4-ligation on oLCs induced IL-10, TGF-beta1, Forkhead box protein 3, IFN-gamma, and IL-2 production in T cells. CONCLUSION: In view of these data, TLR4-ligation on oLCs might not only play a role in pathogen recognition for efficient immunity but also contribute to the tolerogenic state predominating in the oral cavity

Investigation of the expansion properties of osmotic expanders with and without silicone shell in animals.

Contains fulltext : 52572.pdf (publisher's version ) (Closed access)BACKGROUND: Particularly in clinical studies, it has been found that rapid swelling of tissue expanders leads to high-pressure peaks that can cause hypoxia in the tissue and thus also skin damage. For this reason, the present study in animals investigated whether an osmotic expander with silicone shell is capable of expanding in tissue and bringing about useful tissue expansion without complications. It was also examined whether and what quantitative and qualitative differences there are between conventional osmotic expanders and the new expanders with silicone shell. METHODS: The expansion of osmotic expanders with silicone shell was compared with that of osmotic expanders without silicone shell in four mini pigs. The expander type used was an M1 rectangle with an initial volume of 6 ml. Five expanders were implanted in each pig, meaning that 20 expanders were measured. The volume of the expanders was measured directly after explantation. Indirect volume determination was performed by producing plaster casts for subsequent laser optical measurement. RESULTS: Comparison of the two curve profiles showed a much flatter profile for the expanders with silicone shell. The absolute values for the volumes of the expanders with silicone shell were likewise substantially lower. CONCLUSIONS: Controlled skin expansion is a technique of providing localized donor tissue for reconstructive surgery. The new expanders could be in a position to lower the rate of complications in tissue expansion

Decreased gene expression of human beta-defensin-1 in the development of squamous cell carcinoma of the oral cavity.

Item does not contain fulltextThe aim of this study was to investigate the gene expression of human beta-defensin-1, -2, -3 (hBD-1, -2, -3), interleukin-1beta, tumour necrosis factor-alpha and cyclooxygenase-2 in oral squamous cell carcinoma (OSCC) compared to benign and premalignant lesions as well as healthy controls. Biopsies of healthy gingiva (n=5), irritation fibroma (n=5), leukoplakia (n=5) and OSCC (n=5) were obtained during routine surgical procedures. RNA was extracted according to standard protocols and transcripts of hBD-1, -2, -3, interleukin-1beta, tumour necrosis factor-alpha and cyclooxygenase-2 were analysed by real-time polymerase chain reaction. The expression of hBD-1 was reduced in all lesions (5-fold in irritation fibroma and 2.5-fold in leukoplakia), but most significantly (50-fold) in OSCC. hBD-1 appears to play a role in the development of OSCC. The loss of its function might contribute to the malignant progression of these tumours