Tratamiento del Fisurado Labio Alvéolo Palatino (FLAP): casos clínicos y tratamiento interdisciplinario / Treatment of the cleft lip and palate (CLP) patient: case reports and interdisciplinary treatment

Objetivo: Describir el plan de tratamiento completo para el manejo de pacientes con fisura labio alvéolo palatina (F.L.A.P.), basado en nuestra experiencia clínica de más de 40 años. Casos clínicos: En nuestro protocolo consideramos fundamental el tratamiento ortopédico, teniendo en cuenta los tiempos de crecimiento y desarrollo del maxilar superior de cada paciente, para luego aplicar las técnicas quirúrgicas en un maxilar armónico, con un éxito más predecible. Se describirá una serie de casos clínicos con seguimiento de pacientes. Conclusión: Con este protocolo que pregonamos desde hace muchos años, nos diferenciamos principalmente de otras propuestas por considerar los tiempos biológicos de cada paciente en cuanto a crecimiento y desarrollo, y no por basarnos en tiempos quirúrgicos preestablecidos. Aplicando este protocolo obtenemos resultados predecibles que entendemos que solo son posibles de evaluar, al realizar el seguimiento del paciente hasta completar su desarrollo (AU)

Objective: To describe the comprehensive treatment plan aimed at managing patients with cleft lip and palate (CLP) on the basis of our more than forty years of clinical experience. Case reports: e orthopedic treatment is deemed fundamental in the present protocol, which takes into account the maxilla growth and development periods of each individual patient, to later perform a surgical technique in a harmonized maxilla, with a more predictable success. Clinical cases with the patient follow-up shall be described. Conclusion: e main difference between the present protocol that has been held for many years and others proposed approaches mainly lies in considering the unique growth and developmental biological stages of each patient and not in drawing on pre-established surgical timing. When applying this protocol, predictable results are achieved and they are only meant possible to be assessed during the thorough patient follow-up (AU)

Reconstrucción palpebral inferior mediante colgajo de periostio y colgajo de Mustardé / Lower palpebral reconstruction by periosteum flap and Mustardé flap

Paciente masculino de 68 años con carcinoma basocelular lobulado recidivado en inferior izquierdo con colgajo de Hughes hace 5 años y posterior recidiva al siguiente año con escisión en cuña. Actualmente, con una segunda recidiva, se realiza una resección amplia del 75% del total del párpado cuya congelación informa márgenes libres, reconstruido en el mismo acto quirúrgico: la lamela posterior con colgajo pediculado de periostio y la anterior con un colgajo de Mustardé. El paciente evoluciona con un buen sostén y posición palpebral, sin recurrencia del tumor.

A 68-year-old man with recurrent lobulated basal cell carcinoma of the left lower eyelid. She has a history of reconstruction of the lower left eyelid with Hughes flap 5 year sago and later recurrence the following year with wedge excision. Currently, with a second recurrence, resection was performed under frozen section technique and the defect of 75% width free of tumor, is reconstructed in the same surgical act: the posterior lamella with a pedicled periosteal flap and the anterior with a Mustardé flap. One year follow-up, the patient evolves with good support and eyelid position, without recurrence of the tumor.

Injertos óseos en el fisurado labio-alvéolo-palatino (FLAP): casos clínicos / Bone grafts in the cleft lip and palate (CLP) patient: clinical cases

Objetivo: mostrar el tratamiento que realizamos en comunicaciones a nivel del reborde alveolar en los FLAP, tanto para pacientes con fisura unilateral como bilateral, realizados con cresta ilíaca tomada del paciente y basados en nuestra experiencia de más de 40 años. Casos clínicos: nuestro protocolo está dentro de lo que es el tratamiento que proponemos para FLAP, ortopédico y quirúrgico, teniendo en cuenta el crecimiento y desarrollo del maxilar superior, realizando dentro de éste lo que son las periostioplastías y los injertos óseos, con el correspondiente seguimiento de pacientes en el tiempo. Conclusión: se realiza un protocolo adecuado para cada paciente, para realizar el cierre de la comunicación bucosinusal, teniendo siempre en cuenta el crecimiento y desarrollo de cada paciente y no un tiempo fijo en general para todos ellos. Nos diferenciamos de otras personas que lo hacen en forma sistemática en tiempos quirúrgicos preestablecidos, igual para todos los pacientes (AU)

O uso de enxerto e retalho de periósteo em Oftalmologia / The periosteal graft and flap use in Ophthalmology

Resumo Objetivo: Os autores revisaram o uso de periósteo em cirurgias oftalmológicas e seus resultados. Métodos: Uma revisão de literatura usando os bancos de dados do Google Scholar, PubMed e SciElo com todos os artigos sobre o uso de periósteo em Oftalmologia publicados de 1977 até 2018. Resultados: Um total de 21 estudos cumpriram o objetivo do estudo: 9 relatos de caso, 9 séries de casos, 1 coorte retrospective e 2 coortes prospectivas. 206 pacientes foram submetidos aos procedimentos cirúrgicos com uso de periósteo nas duas formas principais: enxerto e retalho. Os principais motivos para uso do periósteo foram: recobrimento de implante orbitário e reconstrução palpebral. Resultados cirúrgicos foram satisfatórios com baixas taxas de complicação de 10.67% e mínima necessidade de nova intervenção cirúrgica de 2.42%. Conclusão: O uso de periósteo em Oftalmologia é uma técnica promissora com bons resultados até o momento e deve sempre ser uma opção terapêutica para o Oftalmologista. Todavia, mais estudos com poder estatístico para sedimentação do conhecimento sobre o tema são recomendados.

Abstract Purpose: The authors reviewed the periosteum use in ophthalmic surgery and its results. Methods: A comprehensive review of the literature using Google Scholar, PubMed and SciElo databases with all articles about the periosteum use in Ophthalmology published from 1977 to 2018. Results: A total of 21 studies followed the review's purpose: 9 case reports, 9 case series, 1 retrospective cohort and 2 prospective cohorts. 206 patients were submitted to the procedures with the periosteum use in the two main forms: graft and flap. The principal reasons for periosteal use were: orbital implant covering and eyelid reconstruction. Surgical outcomes were very satisfactory with low complication rates of 10.67% and minimal necessity of new surgical intervention of 2.42%. Conclusion: The periosteum use in Ophtalmology is a promising technique with good results so far and should always be a therapeutic option for the ophthalmologist. However, based on available data in the literature, more studies with statistical power for knowledge sedimentation in this subject are recommended.

Primary Extraskeletal Osteosarcoma in the Anterior Mediastinum: A Case Report and Review / 대한흉부외과학회지

Extraskeletal osteosarcoma (ESOS) is a malignant soft tissue neoplasm producing osteoid, without any continuity with the bone or periosteum. Primary ESOS presenting in the mediastinum is an extremely rare, yet aggressive malignant tumor associated with a poor prognosis. We report a case of primary ESOS arising from the thymus in a 63-year-old male patient.

Assessment of stem cell viability in the initial healing period in rabbits with a cranial bone defect according to the type and form of scaffold

PURPOSE: Increased bone regeneration has been achieved through the use of stem cells in combination with graft material. However, the survival of transplanted stem cells remains a major concern. The purpose of this study was to evaluate the viability of transplanted mesenchymal stem cells (MSCs) at an early time point (24 hours) based on the type and form of the scaffold used, including type I collagen membrane and synthetic bone. METHODS: The stem cells were obtained from the periosteum of the otherwise healthy dental patients. Four symmetrical circular defects measuring 6 mm in diameter were made in New Zealand white rabbits using a trephine drill. The defects were grafted with 1) synthetic bone (β-tricalcium phosphate/hydroxyapatite [β-TCP/HA]) and 1×105 MSCs, 2) collagen membrane and 1×105 MSCs, 3) β-TCP/HA+collagen membrane and 1×105 MSCs, or 4) β-TCP/HA, a chipped collagen membrane and 1×105 MSCs. Cellular viability and the cell migration rate were analyzed. RESULTS: Cells were easily separated from the collagen membrane, but not from synthetic bone. The number of stem cells attached to synthetic bone in groups 1, 3, and 4 seemed to be similar. Cellular viability in group 2 was significantly higher than in the other groups (P0.05). CONCLUSIONS: This study showed that stem cells can be applied when a membrane is used as a scaffold under no or minimal pressure. When space maintenance is needed, stem cells can be loaded onto synthetic bone with a chipped membrane to enhance the survival rate.

A retrospective computed tomography analysis of maxillary fractures and the clinical outcomes of their unreduced parts

BACKGROUND: Some parts of a maxillary fracture—for example, the medial and posterior walls—may remain unreduced because they are unapproachable or hard to deal with. This study aimed to investigate the self-healing process of unreduced maxillary membranous parts of fractures through a longitudinal computed tomography (CT) analysis of cases of unilateral facial bone injuries involving the maxillary sinus walls.METHODS: Thirty-two patients who had undergone unilateral facial bone reduction surgery involving the maxillary sinus walls without reduction of the medial and posterior walls were analyzed in this retrospective chart review. Preoperative, immediate postoperative, and 3-month postoperative CT scans were analyzed. The maxillary sinus volume was calculated and improvements in bone continuity and alignment were evaluated.RESULTS: The volume of the traumatized maxillary sinuses increased after surgery, and expanded significantly by 3 months postoperatively (p< 0.05). The significant preoperative volume difference between the normal and traumatized sides (p= 0.024) resolved after surgery (p> 0.05), and this resolution was maintained at 3 months postoperatively (p > 0.05). The unreduced parts of the maxillary bone showed improved alignment and continuity (in 75.0% and 90.6% of cases, respectively), and improvements in bone alignment and bone continuity were found to be correlated using the Pearson chi-square test (p= 0.002).CONCLUSION: Maxillary wall remodeling through self-healing occurred concomitantly with an increase in sinus volume and simultaneous improvements in bone alignment and continuity. Midfacial surgeons should be aware of the natural course of unreduced fractured medial and posterior maxillary walls in complex maxillary fractures.

Peripheral osteoma on the medial eyebrow successfully extracted while preserving supratrochlear nerve

Osteomas are benign, slow-growing osteogenic lesions frequently found in the craniomaxillofacial region. They can be classified as peripheral, central, or extraskeletal. Reactive mechanisms to trauma or infection, as well as muscle traction, are thought to play a major role in the development of peripheral osteomas. In the present report, a 41-year-old woman presented with a slow-growing, painless mass on her left eyebrow. She had suffered trauma 15 years prior. In the computed tomography scan, a 2.5 × 2 × 0.7-cm radio-opaque tumor was detected just medial to the left supraorbital foramen, and a peripheral osteoma was clinically diagnosed. An elective operation under general anesthesia was planned. Following a suprabrow incision, subcutaneous and intramuscular dissection was performed. In the surgical plane deep to the corrugator muscles and superficial to periosteum, a branch of the supratrochlear nerve was encountered and preserved using a vessel loop. The osteoma beneath the periosteum was extracted in multiple fragments using a chisel and mallet to minimize trauma to the nerve. Contour and facial symmetry were corrected. To use a suprabrow incision, the surgeon must understand neighboring anatomical structures, including the course of the supratrochlear and supraorbital neurovascular bundles. When these structures are located adjacent to tumor lesions, careful surgical maneuvers should be performed to preserve them.

Primary orbital tuberculosis on the lower eyelid with cold abscess

Orbital tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic areas. It may involve the soft tissue, lacrimal gland, periosteum, or bones of the orbital wall. We present a case of orbital tuberculosis on the lower eyelid. An 18-year-old woman with no underlying disease visited our clinic for evaluation of an oval nodule (1.5× 1.2 cm) on the right lower eyelid. Incision and drainage without biopsy was performed 2 months ago in ophthalmology department, but the periorbital mass had deteriorated, as the patient had erythematous swelling, tenderness, and cervical lymphadenopathy. Visual acuity was normal; there were no signs of proptosis, diplopia, or ophthalmoplegia. Computed tomography revealed a small abscess cavity without bony involvement. We performed an excision and biopsy through a percutaneous incision under local anesthesia. Histological examination revealed a granuloma and was diagnosed as orbital tuberculosis. The patient was additionally treated with anti-tuberculosis therapy for 6 months and recovered without complication or recurrence by 7 months. Orbital tuberculosis occurs in patients with or without associated pulmonary tuberculosis, and should be considered as a differential diagnosis in patients with inflammatory orbital disease and an orbital mass. If recurrence occurs despite adequate initial treatment, we recommend an additional examination and excisional biopsy.

New lower blepharoplasty technique for elderly patients using bony fixation of the sub-orbicularis oculi fat pad

Conventional sub-orbicularis oculi fat (SOOF) lifting during lower blepharoplasty is performed by anchoring the SOOF to the periosteum of the infraorbital rim. This procedure helps to improve the concavity at the central portion of the lower eyelid and the lid-cheek junction. However, over time, the periosteum becomes progressively weaker, diminishing the anchoring effect. This paper introduces a new lower blepharoplasty technique in which the SOOF is fixed to a bony hole to strengthen the holding force and provide sustainability.

Sub-brow blepharoplasty for simultaneous correction of dermatochalasis with upper eyelid hooding and sunken eyelids

Periorbital dermatochalasis with upper eyelid hooding, brow ptosis, and sunken eyelids may appear with age. Because classic blepharoplasty is unable to correct all these issues, we developed a single operation, which we present herein, to correct dermatochalasis accompanied by sunken eyelids. This sub-brow approach is used with simultaneous browpexy by fixing the orbital portion of the orbicularis oculi muscle (OOM) to the periosteum immediately above the supraorbital rim using sutures with 3 or 4 points of fixation and correcting sunken eyelids by burying the elevated dermis, fat, and OOM after de-epithelization in the lower flap of the sunken upper eyelid along the submuscular plane. This method enables the correction of sunken eyelids during the same operation without requiring an additional procedure, and offers the advantages of a shortened operation time and decreased cost. The presence of sunken eyelids in patients with dermatochalasis and severe lateral hooding may be corrected by the procedure described herein, thereby achieving periorbital rejuvenation while maintaining the original shape of the eyes.

Periosteal Graft Myringoplasty: Our Experience

Abstract Introduction Different types of autologous graft materials are used for myringoplasty, with the temporalis fascia and cartilage being the most frequently used tissues. Periosteal tissue has been used for a long time in our department, and many advantages support its use in myringoplasty. To the best of our knowledge, this issue is scarcely discussed in the previously published literature. Objective To present our experience with periosteal graft myringoplasty, describing the technique and the anatomical and functional outcomes. Methods A prospective clinical study involving 88 patients (72 females and 16 males) with a mean age 26.9 years. The patients underwent myringoplasty using the mastoid cortex periosteum; they were all operated using the postauricular approach, and the graft was applied using the underlay technique. The patients performed pre- and postoperative pure tone audiometry for tested frequencies (0.5 kHz, 1 kHz, 2 kHz, and 4 kHz). All patients were followed-up for at least 12 months after the operation. Results The anatomical success rate among all patients was of 93%, which is comparable to the rate of success in procedures using other usual grafting materials. In addition, there was a highly significant postoperative improvement in pure tone audiometry results as compared with the preoperative ones (the main hearing gain was of ∼ 11 dB; p< 0.001). Conclusion The periosteal graft is easily harvested, easy to apply, with excellent anatomical and functional success.

Canine periosteal osteosarcoma / Osteosarcoma periosteal en perro

ABSTRACT Osteosarcoma is the most common bone tumor in dogs. The periosteal osteosarcoma is a subtype of osteosarcoma, and is considered rare in the canine species. The purpose of the present study was to describe a 14-year-old female dog with an ulcerated mass located in the right tibia and 30-days of evolution. The patient was submitted to complementary exams (blood count analysis, dosage of biochemical enzymes - creatinine and alanine aminotransferase, thoracic radiographs, and abdominal ultrasonography) to perform complete staging of the disease. Radiography of the right tibia revealed proliferative and lytic periosteal reaction. The cytological analysis of the mass suggested a round cell tumor. The clinical and the radiological findings indicated the presence of a bone tumor. Pelvic limb amputation was the initial surgical treatment suggested to the client. The histopathological examination revealed the presence of periosteal osteosarcoma with free margins and lymph nodes without evidence of tumor cells. Clinical follow-up was performed through imaging exams without evidence of metastatic disease. The dog had a nine-month survival free time from diagnosis.

RESUMEN El osteosarcoma es el tumor óseo más común en los perros. Osteosarcoma periosteal es un subtipo de osteosarcoma y se considera raro en la especie canina. El objetivo del presente estudio fue describir un caso de una perra mestiza de 14 años de edad con una masa ulcerada y localizada en la tibia derecha y 30 días de evolución. Él paciente se sometió a exámenes adicionales (análisis de sangre, dosis de enzimas bioquímicas - creatinina y alanina aminotransferasa, radiografías torácicas y ultrasonografía abdominal) para la estadificacion completa de la enfermedad. La radiografía de la tibia derecha reveló reacción perióstica proliferativa y lítica. Él examen citológico de la masa sugirió un tumor de celulas redondas. La evaluación clínica y hallazgos radiológicos sugieren la presencia de una neoplasia ósea. La amputación de la extremidad pélvica derecha fue el tratamiento quirúrgico inicial sugerido al cliente. Él examen histopatológico reveló la presencia de osteosarcoma periosteal con márgenes libres y ganglios linfáticos sin evidencia de células tumorales. El seguimiento clínico se realizó a través de exámenes de imágenes sin evidencia de enfermedad metastásica. El perra tenía un tiempo de sobrevida de nueve meses desde el diagnóstico.

Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction

BACKGROUND: Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures. METHODS: A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctivalincision and an elevator through the intraoral incision. RESULTS: The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted. CONCLUSIONS: The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.

Solitary osteochondroma in the body of the pubic bone: a cadaveric case report / 대한해부학회지

Osteochondromas develop as cartilaginous nodules in the periosteum of bones. They are the commonest benign tumors of the skeleton, generally observed in the long bones. Rarely, they are also found in the axial skeleton, flat bones of skull and facial bones. During a regular dissection, we came across a solitary osteochondroma in posterior surface of the body of the right pubic bone. Histopathology of the bony projection confirmed the typical features of the osteochondroma. The symptomatic osteochondromas are usually evaluated during radiographic examination. Though, the observed osteochondroma is relatively smaller its unusual location is remarkable and knowledge of occurrence of such nodules is clinically important during the diagnosis and planning of treatment.

Usefulness of Inferior Turbinate Bone-Periosteal-Mucosal Composite Free Graft for Cerebrospinal Fluid Leakage

BACKGROUND AND OBJECTIVES: Endoscopic repair of cerebrospinal fluid (CSF) leak can avoid morbidity of open approaches and has shown a favorable success rate. Free mucosal graft is a good method, and multi-layered repair is more favorable. The inferior turbinate has been commonly utilized for the free mucosal graft, but we newly designed it as a bone-periosteal-mucosal composite graft for multilayered reconstruction. SUBJECTS AND METHOD: Four subjects with a skull base defect were treated with this method. The inferior turbinate was partially resected including the conchal bone and was trimmed according to defect size. Both bony parts and periosteum were preserved on the basolateral side of the mucosa as a composite graft. The graft was applied to the defect site using an overlay technique. RESULTS: All cases were successfully repaired without any complications. Three of them had a defect size greater than 10–12 mm, and the graft stably repaired the CSF leakage. CONCLUSIONS: Endoscopic repair of CSF leakage using inferior turbinate composite graft is a simple and easy method and would be favorable for defect sizes greater than 10 mm.

A Case of Orbital Lymph Node Misdiagnosed as a Dermoid

PURPOSE: We report our experience with a case of orbital lymph node which has not been previously reported in the Republic of Korea. CASE SUMMARY: A 24-year-old female patient with no underlying disease visited our hospital with a 2-month history of a mass at the lateral side of the left upper eyelid. On physical examination, a round, well-defined subcutaneous mass was palpable, and pain, swelling or a skin change were not reported or seen. The appearance, location, and imaging findings of the mass were suspected to be dermoid, and excisional biopsy was performed for accurate diagnosis and treatment. The 1.0 × 0.7 cm-sized, round-shaped and brown-colored mass was excised. The mass was well-defined but in the posterior part; it was attached to the periosteum. The mass was finally diagnosed as a lymph node with lymphadenitis by histopathological examination. No recurrence or new lesion was observed after surgery, and the patient did not complain of abnormal symptoms. CONCLUSIONS: A Complete orbital lymphoid tissue has not yet been found in the orbit, and lymph nodes are known to be absent. However, as in this case, when an orbital mass is observed, the possibility of lymph node should be considered and histopathological examination should be performed to confirm it.

Parosteal Lipoma Associated with Underlying Recurrent Bizarre Parosteal Osteochondromatous Proliferation (Nora's Lesion) of the Hand / 대한정형외과학회잡지

Parosteal lipoma is a benign tumor of the mature adipose tissue that contacts the periosteum of the underlying bone directly. The tumor commonly arises in the long bones, such as the femur, radius or tibia, and often exhibits underlying osseous changes, such as a cortical hyperostosis or erosion. Parosteal lipoma arising in a finger is rare. Furthermore, there are no reports of parosteal lipoma associated with underlying bizarre parosteal osteochondromatous proliferation. The authors present a rare case of parosteal lipoma of the proximal phalanx of the little finger accompanied by recurrent bizarre paroteal osteochondromatous proliferation in a 64-year-old male patient who had previously undergone an excisional biopsy at the same location 8 years earlier.

Progress relationship between periostin and periodontitis / 华西口腔医学杂志

Periostin, a kind of matricellular protein highly expressed in periodontal ligament and periosteum, is an important regulator of the integrity of periodontal ligament and periodontitis processes. Periostin has been shown to play a positive role in the recovery of periodontitis. This paper reviews relevant literature about the role of periostin in periodontal tissue and periodontitis.

Autogenous distal tibial cancellous bone graft with periosteum for the treatment of cartilage injury of talus with Hepple III-IV type / 中国骨伤

OBJECTIVE@#To analyze the operative methods and clinical effects of autologous distal tibial cancellous bone graft with periosteum in treating cartilage injury of talus with Hepple III-IV type.@*METHODS@#From June 2014 to August 2017, 25 patients (25 feet) with Hepple III to IV cartilage injury of talus were treated with autogenous ipsilateral distal tibial cancellous bone graft. Including 14 males and 11 females, aged from 18 to 52 years with an average of (38.4±3.1) years; left foot was in 8 cases and right foot was in 17 cases. According to Hepple classification, type III of 9 cases, type IV of 16 cases. The curative effect was assessed by Amercian orthopedic foot and ankle society (AOFAS) and visual analogue scale (VAS) before operation and 12 months after operation.@*RESULTS@#All 25 patients were followed up for 12 to 28 months with an average of (14.2±2.5) months. AOFAS and VAS scores were improved from preoperative 53.02±10.06, 8.02±1.14 to 88.04±7.45, 1.26±1.74 at 12 months after operation (<0.05). According to AOFAS standard, 16 cases got excellent results, 6 good, 3 poor.@*CONCLUSIONS@#Autologous distal tibial cancellous bone graft with periosteum is an effective method for Hepple III-IV cartilage injury of talus. It can effectively relieve ankle pain and improve ankle joint function.