Squamous cell carcinoma of the buccal mucosa.

The purpose of this study was to establish treatment criteria for patients with early-stage squamous cell carcinoma of the buccal mucosa. Thirty-one patients were analyzed in a retrospective fashion. Distribution of patients according to tumor stage was relatively even. Within 5 years recurrent disease developed in nearly 80% of evaluable patients. There was a 100% overall incidence of local disease recurrence for patients with stage I and II tumors treated with wide local excision alone and followed up for more than 2 years. On the basis of these data, we conclude that wide local excision for early-stage buccal carcinoma is associated with a high local failure rate. Possible causes for failure and alternative treatment approaches are discussed.     

Microsurgical reconstruction of the buccal mucosa

This article addresses the reconstruction of the buccal mucosa, which is necessary after tumor resection and contracture release.     

Tissue-engineered buccal mucosa urethroplasty-clinical outcomes

INTRODUCTION: Whilst buccal mucosa is the most versatile tissue for urethral replacement, the quest continues for an ideal tissue replacement for the urethra when substantial tissue transfer is needed. Previously we described the development of autologous tissue-engineered buccal mucosa (TEBM). Here we report clinical outcomes of the first human series of its use in substitution urethroplasty. METHODOLOGY: Five patients with urethral stricture secondary to lichen sclerosus (LS) awaiting substantial substitution urethroplasty elected to undergo urethroplasty using TEBM, with full ethics committee support. Buccal mucosa biopsies (0.5 cm) were obtained from each patient. Keratinocytes and fibroblasts were isolated and cultured, seeded onto sterilised donor de-epidermised dermis, and maintained at air-liquid interface for 7-10 d to obtain full-thickness grafts. These grafts were used for urethroplasty in a one-stage (n=2) or a two-stage procedure (n=3). Follow-up was performed at 2 and 6 wk, at 3, 6, 9, and 12 mo, and every 6 mo thereafter. RESULTS: Follow-up ranged from 32 to 37 mo (mean, 33.6). The initial graft take was 100%, as assessed by visual inspection. Subsequently, one patient had complete excision of the grafted urethra and one required partial graft excision, for fibrosis and hyperproliferation of tissue, respectively. Three patients have a patent urethra with the TEBM graft in situ, although all three required some form of instrumentation. CONCLUSIONS: Whilst TEBM may in the future offer a clinically useful autologous urethral replacement tissue, in this group of patients with LS urethral strictures, it was not without complications, namely fibrosis and contraction in two of five patients.     

Non-transecting bulbar urethroplasty using buccal mucosa

Augmentation urethroplasty using oral mucosal graft has become the standard surgical treatment of long bulbar strictures. In very tight strictures the urethral plate is narrowed to the extent that an almost circumferential substitution with oral graft is necessary, with suboptimal results. If the obliterative segment within a longer stricture is short it is possible, through a dorsal stricturotomy, to excise it in a non-transecting manner, leaving the ventral spongiosum intact and anastomose the mucosal edges to reconstitute the urethral plate to an adequate calibre. The stricturotomy is subsequently augmented with an oral mucosal graft. We describe this technique as the augmented non-transecting anastomotic bulbar urethroplasty. It also allows for use of a narrower and shorter graft. In our hands this procedure is associated with a 100% radiological success rate and a 95% patient satisfaction rate at a mean follow-up of 14.8 months (5.7–52.6 months).     

Tissue-engineered buccal mucosa for substitution urethroplasty

OBJECTIVE: To develop tissue-engineered buccal mucosa (TEBM) for use in substitution urethroplasty, as urethral reconstruction is limited by the amount and type of tissue that is available for grafting, and BM has become the favoured tissue for use as a urethral substitute in the last decade. MATERIALS AND METHODS: After enzymatic treatment of a small (0.5 cm) BM biopsy the epidermis and dermis were mechanically separated. Oral keratinocytes were isolated from the epidermis and oral fibroblasts from the dermis. These cells were expanded and applied to sterilized de-epidermized dermis (DED) to obtain a full-thickness TE oral mucosa. Horizontal migration of keratinocytes on the DED was assessed using a tetrazolium-blue (MTT) assay. The TEBM was assessed histologically after mechanical stressing in vitro using catheterization and meshing. RESULTS: Histologically the TEBM closely resembled the native oral mucosa after culturing at an air-liquid interface for 2 weeks. The MTT assay showed good horizontal migration of keratinocytes on the DED. Serial histology revealed a gradually increasing thickness of the epidermis and remodelling of the dermis by the fibroblasts from day 1 to day 14. Despite subjecting the TEBM to mechanical stress the integrity of the epidermal-dermal junction was maintained. CONCLUSIONS: We report the successful culture of full-thickness TEBM for substitution urethroplasty, which is robust and suitable for clinical use.     

How to harvest buccal mucosa from the cheek

The paper provides the reader with the step by step of our current technique of harvesting buccal mucosa from the cheek. We describe how to prepare the patients, the use of the Kilner-Doughty mouth retractor, the Stensen duct identification, the size and the shape of the graft. We discuss how to repair the donor site and how to manage the graft for urethral implantation. Finally the paper presents the preoperative patient evaluation, postoperative course and complications.     

Total proximal ureter substitution using buccal mucosa

The surgical treatment of a long proximal ureteral stricture is a challenging situation for reconstructive surgeons. Despite the underlying morbidities, ileal interposition and autotransplantation are the options available to treat complex cases of long segment ureteral stricture. Buccal mucosa has shown excellent results in urethroplasty. However, its use in ureteral reconstruction is infrequent. We report on a 64‐year‐old female patient with multiple comorbidities and prior abdominal surgeries for Crohn's disease who underwent a successful total substitution of a long segment of the proximal ureter using buccal mucosa. Regular postoperative isotope scans showed improvement in renal function. Based on the pleasant outcome of this case and review of the literature, buccal mucosa might be a viable option with low morbidity in selected cases.     

应用口腔黏膜再造尿道远期观察研究

目的观察口腔黏膜再造尿道的远期外观与结构变化,以及与正常尿道黏膜的差异.明确口腔黏膜用作再造尿道材料的优缺点,以及与尿道下裂术后并发症是否有相关性.探讨用口腔黏膜作再造尿道材料的可行性.方法随访应用口腔黏膜再造尿道患者的远期形态与功能.应用尿道镜观察应用口腔黏膜再造尿道的远期外观.应用光学显微镜观察取自口腔黏膜再造尿道内壁的标本,同时对比观察正常口腔黏膜和尿道黏膜标本.结果应用口腔黏膜再造尿道,远期外形良好,排尿功能正常.再造尿道壁大体外观接近正常,但组织结构仍为典型口腔黏膜.结论应用口腔黏膜再造尿道,远期形态、功能均接近正常尿道,但组织结构没有改变.口腔黏膜是良好的再造尿道组织材料.     

应用口腔黏膜再造尿道远期观察研究

目的观察口腔黏膜再造尿道的远期外观与结构变化,以及与正常尿道黏膜的差异。明确口腔黏膜用作再造尿道材料的优缺点,以及与尿道下裂术后并发症是否有相关性。探讨用口腔黏膜作再造尿道材料的可行性。方法随访应用口腔黏膜再造尿道患者的远期形态与功能。应用尿道镜观察应用口腔黏膜再造尿道的远期外观。应用光学显微镜观察取自口腔黏膜再造尿道内壁的标本,同时对比观察正常口腔黏膜和尿道黏膜标本。结果应用口腔黏膜再造尿道,远期外形良好,排尿功能正常。再造尿道壁大体外观接近正常,但组织结构仍为典型口腔黏膜。结论应用口腔黏膜再造尿道,远期形态、功能均接近正常尿道,但组织结构没有改变。口腔黏膜是良好的再造尿道组织材料。     

Connexin dynamics in the privileged wound healing of the buccal mucosa

Wound closure is fundamental to maintaining tissue homeostasis; a plethora of processes and signals must be coordinated, and gap junctions play a critical role. Some tissues exhibit privileged healing, such as buccal mucosa, repairing more rapidly, but gap junction connexin dynamics during wound healing in such tissues have not been investigated. To determine connexin changes during this rapid healing process, incisional wounds were made in the cheeks of mice and microscopically observed. We discovered that buccal mucosa wound edge keratinocytes do not form a thin tongue of migratory cells like epidermis; instead, a wedge of cells rapidly moves into the wound. The dorsal surfaces of opposing sides of the wounds then touch and join in a “V,” which subsequently fills up with cells to form a “delta” that remodels into a flat sheet. Immunostaining showed that connexin26, connexin30, and connexin43 are expressed at significantly higher levels in the buccal mucosa than the epidermis and that, unlike the skin, all three are rapidly down‐regulated at the wound edge within 6 hours of wounding. This rapid down‐regulation of all three connexins may in part underlie the rapid healing of the buccal mucosa.     

Autologous buccal mucosa graft for hypospadias repair: an initial report.

Autologous buccal mucosa alone or combined with bladder mucosa was used as a free graft for urethral reconstruction in 8 patients with hypospadias. Of these patients 3 with medium penile hypospadias and chordee received a buccal mucosa graft alone and 5 with severe hypospadias received a combined buccal/bladder mucosa graft. Followup at 6 to 18 months showed no complications apart from a fistula in 1 patient with a buccal mucosa graft alone. Our initial results are encouraging. Buccal mucosa seems to be a good material for hypospadias repair.     

组织工程化口腔黏膜应用于尿道修复重建中的进展

利用组织工程化口腔黏膜进行尿道的修复重建是近年来国外研究的方向之一。口腔黏膜细胞的分离、培养及组织工程化口腔黏膜在尿道修复重建中的应用已经在基础实验乃至临床上获得了一定成果。本文综合近年来的文献对组织工程化口腔黏膜在尿路修复重建中的研究进展作一综述。