Temporomandibular Joint Ankylosis in a Girl Child: Immunochemical Evaluation of Tissue Material Obtained from Repeated Arthroplasty Surgeries.

Temporomandibular joint ankylosis (TMJA) is a rare, but debilitating, condition that leads to TMJ joint hypomobility. Surgery is the mainstay for treatment, which is accompanied by rehabilitative and psychological support. Despite the advances in surgical techniques, the recurrence of TMJA post-surgery has been reported as a common complication. Therefore, it becomes essential to investigate and understand the histo-morpho-pathological processes governing these ankylotic changes. Given the lack of such studies in the literature, herein we present a case of a girl child who underwent primary surgery at the age of six years, followed by a second surgery at the age of twelve years. Ankylotic tissue samples collected during both surgeries were studied using various immunohistochemical markers for tissue remodeling, inflammation, antimicrobial activity, and transcriptional regulation. The expression of MMP-2 and -9 was downregulated in repeated surgery materials, whilst MMP-13 was rarely detected in both tissues. Strong MMP-8, TIMP-2, and TIMP-4 expressions were noted in both tissues, showing their anti-inflammatory and protective roles. Moderately strong expression of bFGF, FGFR-1, IL-1α, and TNF-α could indicate sustained tissue growth in the background of inflammation (wound healing). Interestingly, the expression of ß-defensin-2 was found to be constant in both tissues, thereby indicating possible ECM remodeling and collagen breakdown. Finally, a moderate expression of RUNX-2, coupled with a low expression of WNT-1 and -3a, could indicate a slow and delayed bone regeneration process. Our results showcase the complex myriad of pathways that could be involved in the progression of TMJA and post-surgery healing processes. Immunopathological studies could aid in improving the diagnosis, treatment, and prognosis for patients affected with TMJA.

Microsurgical reconstruction of oral defects with free flaps for patients with oral cancer: an 8 year experience with 153 consecutive cases.

OBJECTIVE: Oral squamous cell carcinoma (OSCC) is a common type of cancer affecting people worldwide, with still large proportion of patients diagnosed with the disease in the advanced stage. Due to free vascularised tissue transfers, radical cancer treatment and immediate reconstruction are feasible as a one-stage procedure. The aim of this paper is to evaluate retrospectively our experience with free flap reconstruction of oral defects for patients with oral malignancies in advanced stages. MATERIAL AND METHODS: During the 8-year period, 153 patients with oral cancer had undergone simultaneous extirpation of tumor with or without suspicious lymph node removal and reconstruction of the defect with free flap. A total of 157 free-flap reconstructions had been performed for 153 patients. Accordingly, 116 patients had reconstruction of oral soft tissue defect, but 37 patients had complex soft tissue and bone defect reconstruction. RESULTS: 132 patients had successful free flap surgery with uneventful post surgery period. Flap success rate was 96.8%. Donors site was closed primarily in 58 cases, skin graft was used in 102 cases. Five patients (3.2%) died during post surgery period. Average hospital stay was 20,5 days (from 8 till 44 days). There was no statistically significant correlation found between the patient's age and hospital stay, but hospital stay increased with tumor size (p>0.05). CONCLUSION: The application of the best possible reconstruction method that contributes to the fulfillment of expectations and provision of a good functional and esthetical result is enabled by setting proper, realistic reconstruction goals. Microvascular reconstruction with free flaps for oral defects is a safe method with a very high success rate (96.8%).

Bone Loss around Dental Implants 5 Years after Implantation of Biphasic Calcium Phosphate (HAp/ßTCP) Granules.

Biphasic calcium phosphate ceramic granules (0.5-1.0 mm) with a hydroxyapatite and ß-tricalcium phosphate ratio of 90/10 were used. Biphasic calcium phosphate ceramic granules produced in the Riga Technical University, Riga Rudolph Cimdins Biomaterials Innovation and Development Centre, were used for filling the bone loss on 18 patients with peri-implantitis. After 5 years at the minimum, clinical and 3D cone-beam computed tomography control was done. Clinical situation confirmed good stability of implants without any signs of inflammation around. Radiodensity of the previous gap and alveolar bone horizontally from middle point of dental implants showed similar radiodensity as in normal alveolar bone. This trial is registered with ISRCTN13514478.

Biocompatibility of pure and mixed hydroxyapatite and α-tricalcium phosphate implanted in rabbit bone.

Calcium phosphates and hydroxyapatite, in particular, are used as substitute materials in experimental implantology. These materials are primarily used in hard tissue replacement because their chemical and crystallographic characteristics are considered to be similar to the mineral content, osteoconductivity and bioactivity of normal bone. Cytokines, such as interleukin (IL)-1, IL-6, IL-8, IL-10 and antimicrobial protein ß-defensin-2 (ßDef-2), are used as biomarkers of non-specific reactogenicity. Other biomarkers, including bone morphogenetic protein-2/4 (BMP-2/4), bone regeneration protein osteoprotegerin (OPG), bone matrix protein osteopontin (OP) and osteocalcin (OC), are regarded as specific factors of reactogenicity in bone substitution. The aim of our study was to assess the changes in the distribution and expression of the aforementioned proteins in the lower jaws of rabbits following implantation with pure hydroxyapatite (HAP), α-tricalcium phosphate (α-TCP) or a mix of the two (HAP/α-TCP) manufactured under different temperatures. Our results reveal osteoblast proliferation and regions of granulation tissue formation between biomaterial granules close to the original implantation site, but in the control tissue these changes were less noticeable. Our study showed low variability in the distribution of ßDef-2, OPG and all of the tested interleukins and these proteins were less expressed than BMP2/4, OP and OC. But across all experiments, no statistically significant difference in mean ßDef-2, IL-1, IL-6, IL-8, IL-10, OP, OC, BMP-2/4 and OPG expression in osteocytes was detected between experimental and control groups. We concluded that pure and mixed HAP and α-TCP sintered at different temperatures do not affect the production of cytokines and bone-specific proteins; regions with osteoblast proliferation and low levels of anti-inflammatory cytokines IL-6 and IL-10 indicates better biocompatibility for HAP/α-TCP and α-TCP-2 biomaterials and the moderate number of BMP-2/4- and a prevalence of OC- and OP-positive osteocytes in experimental tissues implanted with HAP at 3 months after implantation indicates potential bone regeneration stimulated by pure HAP.

Growth factors, genes, bone proteins and apoptosis in the temporomandibular joint (TMJ) of children with ankylosis and during disease recurrence.

UNLABELLED: AIM OF STUDY was complex detection of appearance and distribution of growth factors, facial bone growth stimulating genes, ground substance proteins and apoptosis in bone of ankylotic TMJ in primary and repeatedly operated children. MATERIALS AND METHODS: Ankylotic tissue was obtained during the arthroplastic surgery from two 6 years old children (boy and girl) with osseous type of disease. The girl underwent the repeated surgery in TMJ due to the same diagnosis in age of 12 years. Ankylotic tissue was proceeded for detection of BMP2/4, TGFß, Msx2, osteopontin, osteocalcin immunohistochemically, and apoptosis. RESULTS demonstrated massive bone formation intermixed by neochondrogenesis the lack of BMP 2/4, but abundant number of TGFß-containing cells in bone of all tested cases. Despite rich osteopontin positive structures in bone obtained from both - primary and repeated surgery, osteocalcin demonstrated variable appearance in 6 years aged children, but was abundant in joint 5 years later during disease recurrence. Expression of Msx2 varied widely before, but with tendency to decrease stabilized until few positive cells in bone of 12 years old girl. Apoptosis practically was not detected in primarily operated TMJ, but massively affected the supportive tissue in girl with recurrent ankylosis. CONCLUSIONS: The lack of BMP2/4 expression in ankylotic bone proves the disorders in cellular differentiation with simultaneous compensatory intensification of cellular proliferation and/or growth by rich expression of TGFß leading to the remodelling of TMJ. Mainly rich distribution of osteocalcin and osteopontin indicate the intensive mineralization processes of ankylotic bone. Persistent Msx2 expression is characteristic for the supportive tissue of recurrent ankylosis of TMJ and indicates the persistent stimulation of bone growth compensatory limitated by massive increase of programmed cell death.

Upper airway sagittal dimensions in obstructive sleep apnea (OSA) patients and severity of the disease.

OBJECTIVES. To estimate the soft tissue determined individual features of the upper airway sagittal size which may predispose the patient to snoring and OSA and to find whether there is any relationship between the patient's body-mass index (BMI) and the severity of OSA. MATERIAL AND METHODS. 58 consecutive patients with a mean age of 33.4 years were surgically treated for snoring and OSA. Before the operation they were subject to the following: physical examination, a sleep study to determine the severity of sleep disturbed breathing (SDB); the body mass index (BMI) was calculated, lateral cephalometry (LC) was recorded. RESULTS. Snoring was found in 25 patients, OSA I (mild) - 15, OSA II (moderate) - 9, OSA III (severe) - in 9 patients. Among patients with obesity, the most widespread types of sleep disorders were OSA II and OSA III. (p=0.029). There were differences in the mean values of the BMI between the group of snorers and the group with OSA II (p=0.007), between snorers and OSA III (p=0.006). Differences in upper airway cephalometric mean values between groups were found, the thickness of the uvula (SPT) between snorers and OSA III (p=0.001), between the OSA I and OSA III groups (p=0.032), and between the OSA II and OSA III groups (p=0.075). CONCLUSION. Our study found narrowing in the anterior-posterior dimension of the airway at all levels, correlating with the severity of OSA as well as the BMI. The narrowest place was found in the oropharynx with an extension to the hypopharynx.

Functional activity of rabbit salivary glands in reduced and restored regional arterial blood supply conditions.

BACKGROUND: Although the vascular pathology of carotid arteries is widespread, the function of salivary glands in reduced arterial flow conditions is not much investigated clinically and in experiments. At the same time blood supply is a keystone to normal functioning of every organ and especially of salivary secretion. The aim of this study was to estimate functional activity of salivary glands in reduced and restored blood supply conditions in experiment by sialoscintigraphy which is an approved method for functional assessment of salivary glands. METHODS: The ligature of a. carotis communis dextra was performed on 20 Californian rabbits. After 28 days sialoscintigraphy with Tc99 pertechnetate and revascularization through resection of the occluded part of a. carotis communis and reconstruction with venous autograft was performed. One month later sialoscintigraphy was done. RESULTS: The functional activity of rabbit salivary glands after the ligature of a. carotis communis is strongly depressed. The revascularized glands accumulated isotope slowly, but the level of accumulation was higher than on the control side. CONCLUSION: The ligature and reconstruction of a common carotid artery on rabbits confirm the important role of the arterial blood supply in functional activity of salivary glands and may be an appropriate experimental model for investigation of ischemic disease of salivary glands.

Early morphofunctional response of contact tissue after intraosal implantation in rabbit jaw of pure synthetic hydroxyapatite (HAp) bioceramic materials and HAp saturated with lidocaine.

PURPOSE: The aim of this study was to evaluate early morphofunctional response of contact tissue to pure and saturated with lidocaine porous synthetic HAp ceramic implants inserted in holes of rabbit upper jaw. MATERIALS AND METHODS: Pure and saturated with lidocaine cylinders of porous HAp ceramics produced at Biomaterials R&D Laboratory of Riga Technical University were inserted into edentulous part of the upper jaw of 12 New Zealand male rabbits. After two weeks, blocks of soft tissue and bone were taken out. The sections done with EXACT Grunding system and from paraffin blocks were stained with haematoxylin/eosin and by use of biotin-streptavidin immunohistochemistry for transforming growth factor beta1 (TGFbeta1), fibroblast growth factor receptor 1 (FGFR1), interleukin 10 (IL10). Apoptosis was detected by TUNEL method. RESULTS: TGFbeta1 was equally expressed in the bone around HAp implants saturated with lidocaine and without lidocaine, while control sections did not show any expression of TGFbeta. In contacting bone tissue to pure HAp and HAp saturated with lidocaine as well in controls rich expression of FGFR1 was observed. In soft tissue of experimental samples also rich expression of FGFR1 was observed, although it was weak in control samples. IL10 had rich expression in all samples. The mean number of apoptotic cells was higher in samples with pure HAp, slightly decreased in samples HAp with lidocaine and significantly lower in controls. CONCLUSIONS: The expression of TGF beta1 confirms osteoinductive activity of HAp. Contact soft tissue to HAp showed rich FGFR1 expression, and weak in controls suggesting higher plasticity of connective tissue to implants in comparison with supportive tissue. Slightly lower apoptosis in samples of HAp with lidocaine gives evidence of indistinct influence of saturated with lidocaine HAp implants on development of programmed cell death.

5 year experience with lower lip cancer.

Retrospective study of 189 cases of lower lip cancer treated from 1996-2000 is done. There were 69% males and 31% females. Median age was 66.8 years. 84.4% of patients were with tumors stage I-II. Surgical treatment was performed in 83.6% of patients. In all operated cases was squamous cell carcinoma as verrucous tumor in 17.4%, as exophytic in 46% and as ulcerative in 36.6%. There were different methods of local excision, primary reconstruction and neck dissection depending from stage. In the patient group with clinically negative neck at the first attendance (170 patients) delayed cervical metastases developed in 6 patients (3.5%). Recurrence at the primary site developed in 11.3% of patients and was associated with large tumor size and low cancer differentiation. Survival rate at 5-year follow-up was 95% for patients with I stage, 89.7% for II stage and 37% for III and IV stage patients or mean for all group 83.7%. Diagnosis and treatment of actinic cheilitis also is discussed.