Desordens hiperostóticas em American Bully / Hiperostotic disorders in american bully

O complexo de desordens hiperostóticas é uma condição rara e autolimitante, que tem as mesmas características histopatológicas, que cursa com proliferação óssea de caráter não neoplásico. Acomete cães jovens de raças distintas, com variabilidade quanto ao tipo de proliferação óssea e quanto aos ossos acometidos. O complexo é composto pela osteopatia craniomandibular, hiperostose da calota craniana e osteodistrofia hipertrófica. Podendo estar presente nos ossos da calota craniana, mandíbulas, coluna cervical e esqueleto apendicular. O presente relato, descreveu o quadro de uma cadela, da raça American Bully, não castrada, três meses de idade, que foi atendida com queixa de aumento de volume doloroso das mandíbulas, hiporexia e sialorreia há 15 dias, apresentando ao exame físico, amplitude de movimento diminuída e sensibilidade dolorosa da articulação temporomandibular, espessamento firme bilateral do crânio em região de fossa temporal, espessamento palpável de consistência firme das mandíbulas e crepitação respiratória. Após avaliação clínica e realização de exames complementares, chegou-se ao diagnóstico presuntivo, de complexo de desordens hiperostóticas. Foi instituído como conduta terapêutica o suporte analgésico, sendo eficaz para a manutenção das necessidades fisiológicas até a paciente alcançar a fase adulta. O prognóstico para esta paciente foi considerado bom, uma vez que não havia indícios de anquilose da articulação temporomandibular e/ou manifestações neurológicas.

The complex of hyperostotic disorders is a rare and self-limiting condition, which has the same histophatological characteristics, which courses with non-neoplastic bone proliferations. It affects young dogs of different breeds, with variability the bones affected. The complex is composed of craniomandibular osteopathy, calvarial hyperostotic syndrome and hypertrophic osteodystrophy. It may be present in the bones of the skullcap, jaws, cervical spine and appendicular skeleton. The present report describes the condition of a female dog, American Bully breed, entire, three months old, with a complaint of painful swelling of the jaws, hyporexia and drooling for 15 days, presenting on physical examination, reduced amplitude and pain of the temporomandibular joint, bilateral firm thickening of the skull in the temporal fossa region, palpable firm-consistent thickening of the mandibles and respiratory crackle. After clinical evaluation and complementary tests, a presumptive diagnosis of hyperostotic disorders complex was reached. It was instituted pain management as a treatment, being effective for the maintenance of physiological needs until the patient reaches the adulthood. The prognosis for this patient was considered good, since there was no evidence of temporomandibular joint ankylosis and/or neurological manifestations.

A new multiphase calcium phosphate graft material improves bone healing-An in vitro and in vivo analysis.

This study aims to evaluate the potential of a novel biomaterial synthesized from amorphous calcium phosphate (ACP), octacalcium phosphate (OCP), and hydroxyapatite (HA) to repair critical-sized defects (CSD) in rabbit calvaria. In vitro analyses of cell viability, cell proliferation, formation of mineral nodules, and cell differentiation using qPCR were performed for comparing experimental calcium phosphate (ECP), deproteinized bovine bone (DBB), and beta-tricalcium phosphate (ß-TCP). Bilateral CSDs were created in 45 rabbit calvaria. Six groups were evaluated: ECP, ECP + fibrin sealant (ECP + S), coagulum, autogenous bone, DBB, and ß-TCP. Euthanasia was performed at 2, 4, and 8 weeks, followed by micro-computed tomography and histological and immunohistochemical analyses. Results from in vitro analyses revealed similar biocompatibility for all tested materials and a tendency for higher gene expression of some bone markers in the ECP group than in ß-TCP and DBB groups at 7 days. In contrast to that in DBB and ß-TCP groups, ECP displayed growing bone volume over total volume percentage (BV/TV%) with time in vivo. Histological analysis revealed a greater number of giant cells and reduced size of grafted particles in ECP during all periods of analysis. RUNX-2 expression was statistically lower in ECP than DBB at 2 and 4 weeks. Despite no statistical significance, ECP presented the highest absolute values for ALP-expression at 2, 4, and 8 weeks compared with other groups. Together, our findings indicate that a combination of the ACP, OCP, and HA phases into ECP is beneficial and promising for bone regeneration.

Progressive chronic calvarial osteomyelitis in rhino-orbital mucormycosis associated with COVID-19.

We describe two cases of extensive indolent calvarial osteomyelitis after rhino-orbital-mucormycosis in diabetic patients previously diagnosed with COVID-19. Both patients presented with acute rhino-orbital symptoms about one month after being diagnosed with COVID-19. Treatment with intravenous liposomal Amphotericin B and prompt radical surgical debridement was instituted, but calvarial osteomyelitis ensued and persisted chronically despite maintenance of antifungal therapy and partial debridement of necrotic calvarial bone. The patients were discharged to continue antifungal therapy on a day-hospital regime. After more than 8 months of treatment, they remain with radiological signs of osteomyelitis but with no symptoms or intracranial extension of the infection. Calvarial indolent osteomyelitis secondary to mucormycosis is extremely rare, and little is known regarding its treatment. We believe it can be controlled with medical treatment and partial bony debridement although more studies are necessary to better define therapy.

Injerto de hueso calvarial envuelto en colgajo pediculado de fascia temporo-parietal para reconstrucción de reborde cigomático-maxilar e infraorbitario: reporte de caso / Calvarial bone graft wrapped in temporo-parietal fascia pedicled flap for zygomatico-maxillary and infraorbital rim reconstruction: case report

La reconstrucción posterior a una cirugía oncológica resectiva maxilar es todo un desafío. Debido a esto, existen diversas técnicas quirúrgicas cuyo objetivo apunta a mantener no solo la funcionalidad, sino también la estética facial, especialmente en el área del reborde infraorbitario. El injerto de hueso calvarial es una opción segura y versátil para realizar una reconstrucción primaria en el reborde infraorbitario. Esta técnica está indicada en aquellos pacientes en los cuales la resección cutánea y exenteración orbitaria no son necesarias. Por este motivo, a continuación, analizaremos este tipo de injerto a propósito de un caso clínico en el que se usó asociado a un colgajo pediculado de fascia temporoparietal.

Reconstruction after maxillary resective oncological surgery is a challenge. Because of this, there are many surgical techniques whose objective is to maintain not only function but also facial aesthetics, especially in the infraorbital rim area. The calvarial bone graft is a safe and versatile option to perform a primary infraorbital rim reconstruction. This technique is indicated in those patients in whom skin resection and orbital exenteration are not necessary. For this reason, we will now analyze this type of graft in relation to a case in which it was used associated with a temporo-parietal fascia flap.

Optimal Parameters of Laser Therapy to Improve Critical Calvarial Defects.

Body bones play diverse pivotal roles, including the protection of vital organs. For instance, the integrative functions of the brain controlling diverse peripheral actions can be affected by a traumatic injury on the calvaria and the reparative process of a large defect is a challenge in the integrative physiology. Therefore, the development of biomaterials and approaches to improve such defects still requires substantial advances. In this regard, the most attractive approaches have been covering the cavity with inorganic bovine bone (IBB) and, more recently, also using low-level laser therapy (LT), but this issue has opened many questions. Here, it was determined the number of LT sessions required to speed up and to intensify the recovery process of two 5-mm-diameter defects promoted in the calvaria of each subgroup of six adult Wistar rats. The quantitative data showed that 30 days post-surgery, the recovery process by using blood clot-filling was not significantly influenced by the number of LT sessions. However, in the IBB-filled defects, the number of LT sessions markedly contributed to the improvement of the reparative process. Compared to the Control group (non-irradiated), the percentage of mineralization (formation of new bone into the cavities) gradually increased 25, 49, and 52% with, respectively, 4, 7, and 11 sessions of LT. In summary, combining the use of IBB with seven sessions of LT seems to be an optimal approach to greatly improve the recovery of calvarial defects. This translational research opens new avenues targeting better conditions of life for those suffering from large bone traumas and in the present field could contribute to preserve the integrative functions of the brain.

Osteoconductive Effect of a Nanocomposite Membrane Treated with UV Radiation.

Modulation of the bio-regenerative characteristics of materials is an indispensable requirement in tissue engineering. Particularly, in bone tissue engineering, the promotion of the osteoconductive phenomenon determines the elemental property of a material be used therapeutically. In addition to the chemical qualities of the constituent materials, the three-dimensional surface structure plays a fundamental role that various methods are expected to modulate in a number of ways, one most promising of which is the use of different types of radiation. In the present manuscript, we demonstrate in a calvarial defect model, that treatment with ultraviolet irradiation allows modification of the osteoconductive characteristics in a biomaterial formed by gelatin and chitosan, together with the inclusion of hydroxyapatite and titanium oxide nanoparticles.

Processo de neoformação óssea das membranas colágenas Bio-Gide® e Ossix Plus® em defeitos críticos de calvárias: uma análise histomorfométrica e microtomográfica / Bone neoformation process of Bio-Gide® and Ossix Plus® collagen membranes in critical calvaria defects: a histomorphometric and microtomographic analysis

Objetivo: comparar a neoformação óssea em defeitos críticos confeccionados em calvárias de ratos utilizando duas apresentações de membranas de colágeno porcino, Bio-Gide® e Ossix Plus® para o recobrimento da loja cirúrgica criada. Material e Método: trinta e dois ratos machos (Rattus novergicus, Albinus, Wistar) foram divididos entre os grupos BG (membrana de colágeno porcino Bio-Gide®, n=16) e OS (membrana de colágeno porcino Ossix Plus®, n=16). Foram realizados defeitos críticos de 8mm de diâmetro nas calvárias dos animais e estes foram recobertos com as membranas colágenas BG ou OS. Aos 15, 30 e 60 dias os animais foram sacrificados por sobredose anestésica e as amostras coletadas foram submetidas à análise histomorfométrica (t=15, n=8; t=30, n=8 e t=60, n=8) e microtomográfica (t=60, n=8). A análise histomorfométrica foi realizada de forma qualitativa e quantitativa. Os dados histométricos quantitativos e os da análise microtomográfica foram submetidos à estatística (p< 0,05). Resultados: a análise histomorfométrica não apontou diferença no desempenho entre as membranas BG e OS nos períodos de 15, 30 e 60 dias (p> 0,05). Para os dados qualitativos e quantitativos, aos 60 dias pós-operatórios, foram encontradas quantidades consideráveis da membrana OS quando comparada a BG, bem como no parâmetro macroscópico. A análise microtomográfica evidenciou médias superiores para BV, BV/TV, Tb.Th e i.S (p< 0,05) para o grupo OS. Conclusão: a membrana Ossix Plus® apresentou qualidade superior de neoformação óssea, além de permanecer a longo prazo na região dos defeitos críticos produzidos(AU)

Objective: to compare bone neoformation in critical defects made in rat calvaria using two presentations of porcine collagen membranes, Bio-Gide® and Ossix Plus® for covering the surgical pocket created. Material and Method: thirty-two male rats (Rattus novergicus, Albinus, Wistar) were divided between BG (Bio-Gide® porcine collagen membrane, n=16) and OS (Ossix Plus® porcine collagen membrane, n= 16). Critical defects of 8 mm in diameter were made in the animals' calvaria and they were covered with BG or OS collagen membranes. At 15, 30 and 60 days the animals were sacrificed by anesthetic overdose and the samples collected were submitted to histomorphometric (t=15, n=8; t=30, n=8 and t=60, n=8) and microtomographic (t=60, n=8) analysis. The histomorphometric analysis was performed qualitatively. Quantitative histometric and microtomographic data were submitted to statistics (p< 0,05). Results: the histomorphometric analysis showed no difference in performance between the BG and OS membranes in the periods of 15, 30 and 60 days (p> 0.05). For qualitative and quantitative data, at 60 days postoperatively, considerable amounts of OS membrane were found when compared to BG, as well as in the macroscopic parameter. The microtomographic analysis showed higher means for BV, BV/TV, Tb.Th and i.S (p< 0.05) for the OS group. Conclusion: the Ossix Plus® membrane showed superior bone neoformation quality, in addition to remaining longterm in the region of the critical defects produced(AU)

Synthesis of Human Bone Morphogenetic Protein-2 (hBMP-2) in E. coli Periplasmic Space: Its Characterization and Preclinical Testing.

Human BMP-2, a homodimeric protein that belongs to the TGF- ß family, is a recognized osteoinductor due to its capacity of inducing bone regeneration and ectopic bone formation. The administration of its recombinant form is an alternative to autologous bone grafting. A variety of E. coli-derived hBMP-2 has been synthesized through refolding of cytoplasmic inclusion bodies. The present work reports the synthesis, purification, and characterization of periplasmic hBMP-2, obtained directly in its correctly folded and authentic form, i.e., without the initial methionine typical of the cytoplasmic product that can induce undesired immunoreactivity. A bacterial expression vector was constructed including the DsbA signal peptide and the cDNA of hBMP-2. The periplasmic fluid was extracted by osmotic shock and analyzed via SDS-PAGE, Western blotting, and reversed-phase high-performance liquid chromatography (RP-HPLC). The purification was carried out by heparin affinity chromatography, followed by high-performance size-exclusion chromatography (HPSEC). HPSEC was used for qualitative and quantitative analysis of the final product, which showed >95% purity. The classical in vitro bioassay based on the induction of alkaline phosphatase activity in myoblastic murine C2C12 cells and the in vivo bioassay consisting of treating calvarial critical-size defects in rats confirmed its bioactivity, which matched the analogous literature data for hBMP-2.

Synthesis of human bone morphogenetic protein-2 (hBMP-2) in E. coli periplasmic space: its characterization and preclinical testing

Human BMP-2, a homodimeric protein that belongs to the TGF- β family, is a recognized osteoinductor due to its capacity of inducing bone regeneration and ectopic bone formation. The administration of its recombinant form is an alternative to autologous bone grafting. A variety of E. coli-derived hBMP-2 has been synthesized through refolding of cytoplasmic inclusion bodies. The present work reports the synthesis, purification, and characterization of periplasmic hBMP-2, obtained directly in its correctly folded and authentic form, i.e., without the initial methionine typical of the cytoplasmic product that can induce undesired immunoreactivity. A bacterial expression vector was constructed including the DsbA signal peptide and the cDNA of hBMP-2. The periplasmic fluid was extracted by osmotic shock and analyzed via SDS-PAGE, Western blotting, and reversed-phase high-performance liquid chromatography (RP-HPLC). The purification was carried out by heparin affinity chromatography, followed by high-performance size-exclusion chromatography (HPSEC). HPSEC was used for qualitative and quantitative analysis of the final product, which showed >95% purity. The classical in vitro bioassay based on the induction of alkaline phosphatase activity in myoblastic murine C2C12 cells and the in vivo bioassay consisting of treating calvarial critical-size defects in rats confirmed its bioactivity, which matched the analogous literature data for hBMP-2.

5-aminolevulinic Acid and Surgical Margin Analysis in Calvarial Metastasis with Pericranium or Dural Extension: Technical Note

Metastasis to the calvarium with direct pericranium or dural infiltration may be treated with radical surgical removal in selected cases. We describe microsurgical resection of calvarial metastases with fluorescence-guided technique using 5-aminolevulinic acid (5-ALA) in two female patients with breast cancer. Fluorescence findings were positive in both cases. Margins in the scalp and dural layer were 5-ALA negative at the end of surgical removal. Intraoperative pathology was performed in all cases to confirm if oncological limits were free of disease. One case was 5-ALA positive in the outer layer of the dura-mater and another in the pericranium. At the end of the removal in both cases, the surgicalmargins were 5-ALA fluorescence-free. Intraoperative pathology confirmed oncological limits of the resection. 5-aminolevulinic acid fluorescence-guided surgery for calvarial metastases with pericranium and/or dural extension seems to be a safe and reliable method to aid the surgical margins for complete removal, possibly delaying or avoiding adjuvant irradiation for progression control.

Concentration-dependent effects of latex F1-protein fraction incorporated into deproteinized bovine bone and biphasic calcium phosphate on the repair of critical-size bone defects.

F1-protein fraction (F1) is a natural bioactive compound extracted from the rubber tree, Hevea brasiliensis, and has been recently studied for its therapeutic potential in wound healing. In this study, we investigated the concentration-dependent effects of F1 (0.01%, 0.025%, 0.05%, and 0.1%) incorporated into deproteinized bovine bone (DBB) and porous biphasic calcium phosphate (pBCP), on the repair of rat calvarial critical-size bone defects (CSBD). The defects were analyzed by 3D-microtomography and 2D-histomorphometry at 12 weeks postsurgery. The binding efficiency of F1 to pBCP (96.3 ± 1.4%) was higher than that to DBB (67.7 ± 3.3%). In vivo analysis showed a higher bone volume (BV) gain in all defects treated with DBB (except in 0.1% of F1) and pBCP (except in 0.05% and 0.1% of F1) compared to the CSBD without treatment/control group (9.96 ± 2.8 mm3 ). DBB plus 0.025% F1 promoted the highest BV gain (29.7 ± 2.2 mm3 , p < .0001) compared to DBB without F1 and DBB plus 0.01% and 0.1% of F1. In the pBCP group, incorporation of F1 did not promote bone gain when compared to pBCP without F1 (15.9 ± 4.2 mm3 , p > .05). Additionally, a small BV occurred in defects treated with pBCP plus 0.1% F1 (10.4 ± 1.4 mm3, p < .05). In conclusion, F1 showed a higher bone formation potential in combination with DBB than with pBCP, in a concentration-dependent manner. Incorporation of 0.25% F1 into DBB showed the best results with respect to bone formation/repair in CSBD. These results suggest that DBB plus 0.25% F1 can be used as a promising bioactive material for application in bone tissue engineering.

Spontaneous Bone Regeneration After Large Craniectomy in Pediatric Patient.

BACKGROUND: In children, decompressive craniectomy is commonly performed in cases of increased intracranial pressure that is not medically managed. Currently, it is standard practice to perform cranioplasty after decompressive craniectomy, although optimal timing for the procedure remains controversial. To date, few studies have reported spontaneous cranial bone regeneration in children without intervention. CASE DESCRIPTION: A 7-year-old female presented with frontotemporal bone fractures accompanied by dura mater lacerations and brain edema after a motor vehicle accident. She underwent a large decompressive craniectomy and repair of the lacerated dura with a collagen dural substitute. The patient was discharged from the hospital and did not present for follow-up until 10 months after surgery. At that time, computed tomography imaging revealed remarkable spontaneous bone regeneration. With conservative management, she developed enough bone regeneration in the calvarial defect area that cranioplasty surgery was deemed unnecessary. To this date, the patient has no aesthetic deformation of the skull bone and does not exhibit any residual cognitive impairment or motor deficits. CONCLUSIONS: This case report shows that cranial bone regeneration is possible in children older than 6 years old, bypassing the need for cranioplasty after decompressive craniectomy. On the basis of this observation, we recommend that more studies should be performed to identify the factors involved in spontaneous skull bone regeneration in the pediatric population.

Photobiomodulation guided healing in a sub-critical bone defect in calvarias of rats.

BACKGROUND: Photobiomodulation presents stimulatory effects on tissue metabolism, constituting a promising strategy to produce bone tissue healing. OBJECTIVE: the aim of the present study was to investigate the in vivo performance of PBM using an experimental model of cranial bone defect in rats. MATERIAL AND METHODS: rats were distributed in 2 different groups (control group and PBM group). After the surgical procedure to induce cranial bone defects, PBM treatment initiated using a 808 nm laser (100 mW, 30 J/cm2, 3 times/week). After 2 and 6 weeks, animals were euthanized and the samples were retrieved for the histopathological, histomorphometric, picrosirius red staining and immunohistochemistry analysis. RESULTS: Histology analysis demonstrated that for PBM most of the bone defect was filled with newly formed bone (with a more mature aspect when compared to CG). Histomorphomeric analysis also demonstrated a higher amount of newly formed bone deposition in the irradiated animals, 2 weeks post-surgery. Furthermore, there was a more intense deposition of collagen for PBM, with ticker fibers. Results from Runx-2 immunohistochemistry demonstrated that a higher immunostaining for CG 2 week's post-surgery and no other difference was observed for Rank-L immunostaining. CONCLUSION: This current study concluded that the use of PBM was effective in stimulating newly formed bone and collagen fiber deposition in the sub-critical bone defect, being a promising strategy for bone tissue engineering.

Investigation of various events occurring in the brain tissue after calvarial defects in rats / Investigación de las alteraciones ocurridas en el tejido cerebral posterior a la creación de defectos en la calvaria de ratas

Bone damage and accidents, traumas can alter people's normal life, and damage the soft tissues. In this study, we aimed to investigate in calvarial defects in rats depending on the severity of cerebral contusion injury occurring in the temporal region. The rats were randomly divided into two groups: group 1 (control group), critical size cranial model with no treatment (n= 10); group 2 (14-day synthetic graft group given 7th day DEXA), critical size cranial model treated with Dexamethasone (0.05 mg/kg intramuscular injection) +Synthetic graft (n= 10) One calvarium defect of 7 mm was made in the parietal bone of each animal under general anesthesia. Calvarial defect results in dilatation of blood vessels, hemorrhage and deterioration was observed in glial fibrillary structures. Additionally, the increase in vascular endothelial growth factor expression showed a positive reaction with glial fibrillary acid protein astrocytes extensions. Apoptotic glial cells stained positive with Bcl-2. Calvarial defects caused by mild brain injury, to be induced by inflammatory cytokines, interrupting glial fibrillary degeneration by affecting the blood brain barrier is thought to promote apoptotic changes.

Daños óseos, accidentes y traumas pueden alterar la vida normal de las personas y dañar los tejidos blandos. Este estudio tuvo como objetivo investigar los defectos de calota en ratas en función de la gravedad de la lesión cerebral que ocurre en una contusión de la región temporal. Las ratas fueron divididas aleatoriamente en dos grupos: al grupo 1 (control), se le realizó un modelo de defecto craneal de tamaño crítico sin tratamiento (n= 10) y al grupo 2, se le realizó un modelo de defecto craneal de tamaño crítico que fue tratado con dexametasona (0,05 mg/kg vía i.m.) + injerto sintético (n= 10) (14 d con injerto sintético y el día 7 se le administró dexametasona). El modelo generó un defecto de 7 mm en el hueso parietal en cada animal, bajo anestesia general. Los defectos craneales produjeron dilatación de los vasos sanguíneos, hemorragias y deterioro en las estructuras gliales fibrilares. Además, el aumento de la expresión del factor de crecimiento vascular endotelial mostró una reacción con las positiva con la proteína ácida fibrilar de la glía el las extensiones de los astrocitos. Las células gliales apoptóticas se tiñeron positivas con Bcl-2. Los defectos de calota causan una lesión cerebral leve, inducidas por citoquinas inflamatorias, las que interrumpen la degeneración glial fibrilar al afectar la barrera hematoencefálica, induciendo cambios apoptóticos.

Survival rate of osseointegrated implants in atrophic maxillae grafted with calvarial bone: a retrospective study.

The aim of this study was to evaluate the clinical survival rate of osseointegrated implants placed in the atrophic maxilla that has been reconstructed by means of autogenous bone grafts harvested from a cranial calvarial site. Further, we sought to analyse the level of peri-implant bone after prosthetic rehabilitation and to determine subjective patient satisfaction with the treatment performed. This study conformed to the STROBE guidelines regarding retrospective studies. Twenty-five patients who had received osseointegrated implants with late loading in the reconstructed atrophic maxilla were included in the study. The survival rate and level of peri-implant bone loss were evaluated. A questionnaire related to the surgical and prosthetic procedures was completed. The observed implant survival rate was 92.35%. The mean bone loss recorded was 1.76mm in the maxilla and 1.54mm in the mandible. The results of the questionnaire indicated a high level of patient satisfaction, little surgical discomfort, and that the patients would recommend the procedure and would undergo the treatment again. From the results obtained, it is concluded that the cranial calvarial site is an excellent donor area; calvarial grafts provided stability and maintenance of bone volume over the course of up to 11 years.

Reconstrução de maxila severamente atrófica via enxerto ósseo autógeno de calota craniana: descrição de técnica / Reconstruction of severely atrophic maxillary using calvarial autogenous bone graft: technical description

As reconstruções ósseas são tradicionalmente realizadas por meio de enxertos autógenos coletados de áreas doadoras intra e extrabucais, visando o restabelecimento do arcabouço perdido para posterior reabilitação implantoprotética. A calota craniana tem sido estudada como excelente opção em grandes atrofias, com baixa incidência de reabsorções, bem como de complicações e morbidade mínima. O tempo de hospitalização é curto, com baixo nível de dor, pequena limitação funcional e cicatriz imperceptível. A microarquitetura da calota craniana é predominantemente cortical com a presença de fatores de crescimento que evidenciam sua capacidade osteogênica, osteoindutora e osteocondutora acarretando baixa porcentagem de reabsorção e alta previsibilidade quando comparada a crista do ilíaco. Lacerações durais, hemorragias extra e subdurais, fístulas liquóricas e lesões cerebrais tem sido minimizadas em virtude do desenvolvimento da técnica cirúrgica. A delimitação da camada diploica, preservando a cortical interna do crânio, antes da realização das osteotomias no leito doador, possibilitou a diminuição de acidentes e complicações. O objetivo deste artigo foi apresentar nota técnica e discutir aspectos relativos à aplicação do osso de calota craniana na reconstrução de maxilas severamente atróficas, visando à reabilitação oral com implantes osseointegráveis.

Bone reconstructions are traditionally conducted with autogenous grafts harvested from intra- or extra-oral donor sites to reestablish the lost bone volume for further implant-prosthetic rehabilitation. The calvarial bone has been studied as an excellent donor site in large atrophic situations, presenting low resorption rates, as well as complications and minimal morbidity. The hospitalization time is short, with low pain levels, short functional limitations, and invisible scars. The skull microarchitecture is predominantly cortical in the presence of growth factors that demonstrate their osteogenic, osteoinductive, and osteoconductive abilities resulting in low resorption rate and high predictability when compared to the iliac crest. Dural lacerations, extra and subdural bleeding, cerebrospinal fluid leakage, and brain damage have been minimized due to the development of surgical technique. The delimitation of diploe, preserving the internal skull cortex before osteotomy at the donor made it possible to reduce accidents and complications. The aim of this paper is to show a technical and to discuss aspects of the use of calvarial bone in the reconstruction of severely atrophic maxilla for oral rehabilitation with osseointegrated implants.

Exploring anorganic bovine bone granules as osteoblast carriers for bone bioengineering: a study in rat critical-size calvarial defects

It is known that current trends on bone bioengineering seek ideal scaffolds and explore innovative methods to restore tissue function. In this way, the objective of this study was to evaluate the behavior of anorganic bovine bone as osteoblast carrier in critical-size calvarial defects. MC3T3-E1 osteoblast cells (1x10(5) cells/well) were cultured on granules of anorganic bovine bone in 24-well plates and after 24 h these granules were implanted into rat critical-size calvarial defects (group Biomaterial + Cells). In addition, other groups were established with different fillings of the defect: Blood Clot (negative control); Autogenous Bone (positive control); Biomaterial (only granules) and Cells (only MC3T3-E1 cells). After 30 days, the animals were euthanized and the calvaria were technically processed in order to allow histological and morphometric analysis. It was possible to detect blood vessels, connective tissue and newly formed bone in all groups. Particularly in the Biomaterial + Cells group, it was possible to observe a profile of biological events between the positive control group (autogenous bone) and the group in which only anorganic bovine granules were implanted. Altogether, the results of the present study showed that granules of anorganic bovine bone can be used as carrier to osteoblasts and that adding growth factors at the moment of implantation should maximize these results.

Sabe-se que uma das atuais tendências na bioengenharia óssea é procurar um carreador ideal e explorar métodos inovadores para restaurar a função do tecido. Desta forma, nosso objetivo foi avaliar o comportamento do osso bovino inorgânico como carreador de osteoblastos em defeitos ósseos de tamanho crítico em calvária de ratos. Osteoblastos da linhagem MC3T3-E1 (1x10(5) células/poço) foram cultivadas em grânulos de osso bovino inorgânico sob placas de 24 poços e após 24 h esses grânulos foram implantados em defeitos ósseos de tamanho crítico em calvária de ratos. Além deste grupo experimental (Biomaterial + Células), foram estabelecidos outros grupos com diferentes preenchimentos do defeito crítico: coágulo sanguíneo (controle negativo); osso autógeno (controle positivo); Biomaterial (apenas grânulos) e Células (apenas células MC3T3-E1). Após 30 dias, os animais foram eutanasiados e as calvárias foram processadas histotecnicamente, a fim de permitir a análise histológica e morfometria. Nossos resultados mostraram que em todos os grupos avaliados foi possível detectar vasos sanguíneos, tecido conjuntivo e osso neoformado. Em especial para o grupo tratado com Biomaterial + Células, foi possível observar um perfil de eventos biológicos intermediário ao grupo controle positivo (osso autógeno) e o grupo de biomaterial (apenas grânulos inorgânico bovino). Ao todo, nossos resultados mostraram que os grânulos de osso bovino inorgânico podem ser usados como carreador de osteoblastos e que a adição de fatores de crescimento no momento em que ocorre o implante deve maximizar os resultados.

A comparative study of variation of the pterion of human skulls from 13th and 20th century Anatolia / Un estudio comparativo de la variación del pterion en cráneos humanos de los siglos 13 y 20 de Anatolia

The pterion is a commonly used anthropologic and neurosurgical landmark defined as the junction of the sphenoid, temporal, parietal and frontal bones. It is commonly classified into four types based on sutural pattern: sphenoparietal, in which the sphenoid and parietal bones are in direct contact; frontotemporal, in which the frontal and temporal bones are in direct contact; stellate, in which all four bones come into contact at a point; and epipteric, in which a small sutural bone is found between the parietal bone and the greater wing of the sphenoid bone. In the present study, 44 Anatolian skulls from two different eras, Byzantine (13th century) and contemporary (20th century), were investigated for morphology and location of the pterion. Sphenoparietal was the most common form, comprising 87.5 percent and 89.2 percent in the Byzantine and contemporary groups, respectively. The frequencies of the epipteric type of pterion were 6.25 percent and 3.6 percent in the Byzantine and contemporary groups, respectively. Measurements of the location of the pterion were made by using stainless steel calipers and Scion Image software. There were no significant differences in digital and manual measurements between the right and left sides of the skulls in both groups. However, the distance from the pterion to the inion was significantly greater in the manual measurements compared to the digital measurements. Anatomical variations of the pterion, which are of interest to anthropologists, forensic pathologists and surgeons, deserve further investigation in other populations from different geographical areas.

El pterion es un punto comúnmente usado como punto de referencia antropológico y neuroquirúrgico, correspondiendo a la unión de los huesos esfenoides, temporal, parietal y frontal. Generalmente es clasificado en 4 tipos basado en padrones suturales: esfenoparietal, en el cual los huesos esfenoides y parietal están directamente en contacto; frontotemporal, en el cual el frontal y el temporal se encuentran en contacto directo; estrellado, en el cual los cuatro huesos mencionados se contactan directamente en un punto y epiptérico, en el cual un pequeño hueso sutural se encuentra entre el hueso parietal y el ala mayor del esfenoides. En el presente estudio, investigamos la morfología y la localización del pterion en 44 cráneos Anatolian de diferentes épocas, Bizantina (Siglo XIII) y contemporánea (Siglo XX). La forma más común que se encontró fue la Esfenoparietal, con un 87,5 por ciento para los del grupo Bizantino y 89,2 por ciento para los de la era contemporánea. La frecuencia del tipo epiptérico fue de 6,25 por ciento y 3,6 por ciento, respectivamente. Se realizaron medidas de la posición del pterion utilizando un caliper y un software de imágenes. No hubo diferencias estadísticamente significativas en las mediciones manuales y digitales entre los lados derecho e izquierdo de los cráneos de ambos grupos. Sin embargo, la distancia desde el pterion al inion fue significativamente mayor en las medidas manuales comparadas con las digitales. Las variaciones anatómicas del pterion, las cuales son de interés para antropólogos, patólogos forenses y cirujanos, son un tema de investigación a desarrollar en otras poblaciones de diferentes áreas geográficas.