A Novel Injection Technique to the Lateral Pterygoid Muscle for Temporomandibular Disorders: A Cadaveric Study.

BACKGROUND: Lateral pterygoid muscle activity is associated with the pathological mechanisms of some temporomandibular disorders. The authors aimed to define and demonstrate a novel, practical, and safe technique for botulinum toxin type A injection to the lateral pterygoid muscle based on their findings. Their secondary aims were to standardize the injection pattern according to the variations of the lateral pterygoid muscle and its surrounding anatomical structures, and to establish its advantages over intraoral injection. METHODS: Twenty cadaver heads were dissected. The lateral pterygoid muscle and its surrounding structures were investigated for anatomical variations. Based on these findings, a standardized extraoral injection protocol was defined and compared with the intraoral technique for accuracy and safety. RESULTS: The average depth of the lateral pterygoid plate from the skin surface was 49.9 ± 2.2 mm, and the mean width of the lateral pterygoid plate was 10.5 ± 3.9 mm. The extraoral injection approach based on the location of the maxillary tuberosity, tragus, and lateral pterygoid plate was consistent in all dissections for the accuracy of the intramuscular injection. In the intraoral approach, standardization of the entry point of the needle through the oral mucosa is difficult, which makes adjustment of the depth of the injection challenging while increasing the risk of neurovascular injury. CONCLUSIONS: The clinical significance of the lateral pterygoid muscle makes it worthwhile to implement minimally invasive treatments before considering more invasive options. The authors define a safe, accurate, and reliable approach with ease of administration in patients with temporomandibular disorders.

Stem Cell Based Exosomes: Are They Effective in Disease or Health?

Exosomes are nano-sized vesicles involved in intercellular communication via delivery of molecules including lipids, nucleic acids, proteins, or other cellular components to distant or neighboring sites. Their ability to pass biological barriers, stability in physiological fluids without degradation, and distinctive affinity to target cells make exosomes very remarkable therapeutic vehicles. Virus-based approaches are some of the most widely used gene therapy methods; however, there are many issues need to be clarified such as high immunogenicity. Using of the exosomes procures the functional transfer of their cargo with minimal intervention from the immune system and it has been reported to be secure and well-tolerated. When the regenerative medicine is taken into consideration, stem cell-based approaches have been aimed to utilize but the general efficacy and safety profile of stem cell therapy has still not been enlightened. At this point, stem cell-derived exosomes exhibit a way to procure cell-free regenerative medicine with their unique characteristics. Exosomes are considered as appropriate and highly stable biological nano-vectors taking part in a wide variety of healthy and pathological processes for advanced targeted therapies. However, there are still crucial obstacles to achieve efficient isolation of large amount of specific and pure exosomes. Thus, large-scale exosome production under good manufacturing practice is required. The purpose of this review is to focus on stem cell-based exosomes for gene delivery and to introduce synthetic exosome-mimics as a potential alternative in the field of targeted gene therapies. Further, we aim to highlight the biobanking and large-scale manufacturing methods of exosomes.

Different Aspects of Head and Neck Squamous Cell Carcinoma: Cancer Stem Cells, their Niche and Targeted Therapy.

Head and Neck Squamous Cell Carcinoma (HNSCC) is categorized as the sixth most common cancer worldwide, with an incidence of more than 830,000 cases per year and a mortality rate of 50%. Tobacco use, alcohol consumption, and Human Papillomavirus infection are the prominent risks for HNSCC. Despite significant developments in the treatment of HNSCC, a high rate of recurrences makes the clinical situation worse and results in poor survival rates. Recent perspectives demonstrate that although epithelial transformation plays a crucial role in cancer development, tumor surrounding microenvironment takes part in the progression of cancer as well. Cancer Stem Cells (CSCs), which harbor unlimited self-renewal capacity, have a crucial role in the growth of HNSCC and this cell population is responsible for tumor recurrence unless eliminated by targeted therapy. CSCs are not only a promising target for tumor therapy but also a crucial biomarker to determine the patients at high risk for undetermined results and disease development, just as the bone marrow, which is the niche of hematopoietic and mesenchymal stem cells, is important for stem cell maintenance. Similarly, the concept of microenvironment is also important for the maintenance of CSCs. Apart from the cell-cell interactions, there are many parameters in the cancer microenvironment that affect the development of cancer, such as extracellular regulation, vascularization, microbial flora, pH, and oxygenation. The purpose of this review is to introduce HNSCC, explain the role of CSCs and their microenvironment, and refer to the conventional and novel targeted therapy for HNSCC and CSCs.

In Vitro Evaluation of the Primary Stability of Short Implants in Different Surgical Techniques.

PURPOSE: This study was designed to evaluate the effects of four different surgical techniques on the primary stability of short implants in two sizes (4-mm and 6-mm length) through resonance frequency analysis and insertion torque measurement in vitro. MATERIALS AND METHODS: Forty implant site preparations and implant insertions were performed in pig ribs. Guided surgery, bone condensing, conventional drilling, and undersized preparation surgical techniques were used five times in each bone block to prepare 4-mm/6-mm-length implant beds. The maximum insertion torque and implant stability quotient (ISQ) values were recorded for each implant. RESULTS: Both the ISQ and torque differed significantly for various surgical techniques (P = .009 and P < .001). The conventional technique had higher ISQ (79.00), whereas the condenser technique had higher torque (48.00 Ncm) than did the other techniques. The mean torque was significantly higher in all surgical techniques other than the guided surgery group regardless of implant length (P < .01 for all). Implant lengths were not significantly different in terms of ISQ and torque in all surgical techniques. CONCLUSION: There are significant correlations between the implant bed preparation technique and primary implant stability when using short implants. Conventional surgery and the bone condensing technique are favorable alternatives with higher primary stability and torque values in short implants.

Finite element analysis of stress distribution on reconstructed mandibular models for autogenous bone grafts.

BACKGROUND: There are several challenges in terms of mandibular reconstruction. The defect size, graft materials, and plate combinations should be taken into consideration in surgical planning. OBJECTIVE: The aim of this study was to evaluate the effect of different reconstruction variations on the stress distribution of segmental resected mandibles with two different defect sizes using finite element analysis (FEA). METHODS: Computerized tomography images of a human mandible, fibula, and iliac crest were used as references to build three-dimensional (3D) models on a PC. The virtual plates and screws were used to simulate reconstruction of the mandibular defects. The models were divided into two groups based on the longitudinal defect size. Different osteosynthesis variations and autogenous graft material combinations were used to reconstruct the mandibles. RESULTS: In all models, higher von Mises stress values occurred on the mandibles reconstructed with the fibula than those with the iliac crest. Fixation of the bone grafts with a reconstruction plate for the 10-mm defects and using a mini-plate in addition to the reconstruction plate for the 30-mm defects decreased stresses on the grafted bones. CONCLUSIONS: Mandibular reconstruction with the iliac grafts is biomechanically superior to that with the fibular grafts. In addition, osteosynthesis methods and the defect size affect the stress distribution.