Recent advances in reconstructive oral and maxillofacial surgery

Reconstruction within the head and neck is challenging. Defects can be anatomically complex and may already be compromised by scarring, inflammation, and infection. Tissue grafts and vascularised flaps (either pedicled or free) bring healthy tissue to a compromised wound for optimal healing and are the current gold standard for the repair of such defects, but disadvantages are their limited availability, the difficulty of shaping the flap to fit the defect and, most importantly, donor site morbidity. The importance of function and aesthetics has driven advances in the accuracy of surgical techniques. We discuss current advances in reconstruction within oral and maxillofacial surgery. Developments in navigation, three-dimensional imaging, stereolithographic models, and the use of custom-made implants can aid and improve the accuracy of existing reconstructive methods. Robotic surgery, which does not modify existing techniques of reconstruction, allows access, resection of tumours, and reconstruction with conventional free flap techniques in the oropharynx without the need for mandibulotomy. Tissue engineering and distraction osteogenesis avoid the need for autologous tissue transfer and can therefore be seen as more conservative methods of reconstruction. Recently, facial allotransplantation has allowed whole anatomical facial units to be replaced with the possibility of sensory recovery and reanimation being completed in a single procedure. However, patients who have facial allotransplants are subject to life-long immunosuppression so this method of reconstruction should be limited to selected cases.     

Dedifferentiated Fat (DFAT) cells: A cell source for oral and maxillofacial tissue engineering

Tissue engineering is a promising method for the regeneration of oral and maxillofacial tissues. Proper selection of a cell source is important for the desired application. This review describes the discovery and usefulness of dedifferentiated fat (DFAT) cells as a cell source for tissue engineering. Dedifferentiated Fat cells are a highly homogeneous cell population (high purity), highly proliferative, and possess a multilineage potential for differentiation into various cell types under proper in vitro inducing conditions and in vivo. Moreover, DFAT cells have a higher differentiation capability of becoming osteoblasts, chondrocytes, and adipocytes than do bone marrow‐derived mesenchymal stem cells and/or adipose tissue‐derived stem cells. The usefulness of DFAT cells in vivo for periodontal tissue, bone, peripheral nerve, muscle, cartilage, and fat tissue regeneration was reported. Dedifferentiated Fat cells obtained from the human buccal fat pad (BFP) are a minimally invasive procedure with limited esthetic complications for patients. The BFP is a convenient and accessible anatomical site to harvest DFAT cells for dentists and oral surgeons, and thus is a promising cell source for oral and maxillofacial tissue engineering.     

Constructs and scaffolds employed to regenerate dental tissue

Dental tissue injury and regeneration affects the daily lives of almost everyone. Tissue engineering is emerging as a promising therapy to regenerate missing teeth and dental tissues. The aim of regenerative dental therapies is to restore patients to full oral health. This means restoring normal function to missing or damaged tissue. Regeneration approaches use a combination of scaffolds, stem cells, growth factors, tissue engineering, organ tissue culture, transplantation, and tissue grafting. There are 8 key elements to create and use tissue constructs for tissue regeneration. These will be described in detail in this article.     

颌面部软组织缺损性创伤的急诊治疗

目的 :探讨颌面部软组织缺损性创伤的急诊治疗效果和经验。方法 :对本院急诊科收治的128例颌面部软组织缺损性创伤的临床资料进行统计,就创伤的原因、部位、缺损面积、治疗方法及效果等问题进行临床分析。结果:128例中,应用随意皮瓣修复缺损98例,占76.56%;轴型皮瓣修复30例,占23.44%。本组病例缺损面积最大者3.8 cm×3.2 cm,最小者1.5 cm×0.8 cm,均获得满意的整形治疗效果。结论 :颌面部创伤严重威胁着人类的生命和健康,应用整形外科技术急诊治疗颌面部软组织缺损性创伤,有利于受损组织血运的恢复,提高了创伤的治疗效果。     

Soft tissue‐related complications and management around dental implants

Implant installation for replacing missing teeth is a frequent treatment procedure with high long‐term survival and success rates. However, the success of implant therapy may be jeopardized by several complications related to mistakes in treatment planning, surgical procedure, management of hard and soft tissues, and infections. Increasing evidence suggests that the stability of the soft tissues surrounding osseointegrated dental implants may substantially influence long‐term clinical stability and esthetics. Therefore, when implant therapy is planned, the clinician must not only be able to perform the appropriate steps to maintain/create a stable soft tissue, but also needs to be aware of the potential sources for complications and possess the adequate knowledge for their appropriate management. The present paper provides an overview of the most important aspects related to the prevention and management of soft tissue‐related complications in conjunction with implant therapy. The current literature indicates that the presence of an adequate width of keratinized attached mucosa around dental implants may lead to better soft and hard tissue stability, less plaque accumulation, limited soft tissue recession, and lower incidence of peri‐implant mucositis. Proper implant positioning by carefully considering appropriate mesio‐distal and bucco‐lingual dimensions and implant angulation may prevent the loss of interdental soft tissues and development of soft tissue recessions. To optimize the width of keratinized attached mucosa, the appropriate soft tissue augmentation protocol should be selected for each particular indication. When the use of autogenous soft tissue grafts is planned, a thorough knowledge of the anatomical structures is mandatory in order to harvest soft tissue grafts of an appropriate quality and quantity and to avoid/minimize postoperative complications. Finally, the clinician needs to master the necessary steps in order to manage complications related to extensive bleeding and tissue necrosis that may occur in conjunction with soft tissue augmentation procedures.     

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??Maxillofacial soft and hard tissue?? which has special anatomical site and physical structure?? plays a vital role in the mastication?? pronunciation?? appearance and other physical functions in human. However?? maxillofacial tissue is vulnerable to trauma?? infection and congenital diseases. Maxillofacial tissue defects are very common in clinical practice?? seriously affecting the physiological function and life quality of patients. Nowadays?? the major repair methods applied in clinic are autologous transplantation?? which results in second trauma and incomplete structural and functional repair?? so the reconstruction of maxillofacial tissue defect is a difficult clinical problem urgent to be solved. The maxillofacial soft tissue has complex composition and structure and is directly exposed to saliva?? which is more demanding for repair materials and repair strategies. In recent years?? with the development of tissue engineering and regenerative medicine?? more and more attention has been paid to the regeneration of maxillofacial region?? which provides a promising treatment strategy for maxillofacial soft tissue defects. In this paper?? the research progress of the maxillofacial soft tissue regeneration?? which mainly refers to seed cells?? growth factors?? biological scaffold and repair strategies??is reviewed.     

口腔颌面软组织损伤的再生修复策略

颌面部软、硬组织具有特殊的解剖部位和生理结构,在人体咀嚼、发音、美观等方面起着至关重要的作用,同时很容易受到创伤、感染和先天性疾病等的影响。颌面部组织缺损在临床上十分常见,严重影响患者的生理功能和生活质量,而现有的临床修复方法以自体软、硬组织移植修复为主,会导致二次创伤且不利于塑形。因此,颌面组织缺损修复是临床亟待解决的难题。其中,颌面软组织的解剖结构和组织成分复杂,并与唾液相接触,对相关修复材料和修复策略的研发提出了更高要求。近年来,随着组织工程和再生医学的发展,口腔颌面部再生领域受到越来越多的重视,为口腔颌面软组织缺损提供了极具前景的治疗策略。文章对口腔颌面部软组织再生领域相关的种子细胞、生长因子、生物支架以及修复策略的研究进展做一综述。     

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动静脉畸形(arteriovenous malformations,AVM)为高血流血管畸形,口腔颌面部软组织内及颌骨中均可发生。主要临床表现为病变区皮色改变、皮温增高伴搏动,听诊可闻及吹风样杂音;严重者可出现明显面部畸形,并可发生溃疡及出血。治疗方法主要为血管内栓塞或硬化及手术治疗。本文介绍了栓塞治疗的方法及注意事项,并根据软组织及颌骨AVM的血管构筑特点探讨了其治疗的要点与疗效。软组织AVM的治疗应首选血管内栓塞或硬化治疗,对于存在严重面部畸形的病例可结合手术治疗。对于颌骨AVM尤其是发生大出血的病例,栓塞后行颌骨刮治术疗效确切,可有效避免复发。     

Oral and maxillofacial surgery residency education

Oral and maxillofacial surgery is the recognized specialty of dentistry that is responsible for the diagnosis and surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the bone and soft tissues of the oral and maxillofacial region. This article will present a review of the educational process for residents in oral and maxillofacial surgery as it has evolved and current training standards.     

口腔骨组织工程研究进展

创伤、炎症、肿瘤、先天畸形所引起口腔颌面部骨缺损的修复一直是口腔医学的难题,而组织工程已成为骨缺损修复新的研究热点。下面就骨组织工程及其在口腔医学领域的研究进展作一综述。     

The impact of tissue engineering on dentistry

BACKGROUND: Tissue engineering is a novel and highly exciting field of research that aims to repair damaged tissues as well as create replacement (bioartificial) organs. OVERVIEW: The authors provide a general review of the principles underlying key tissue engineering strategies, as well as the typical components used. Several examples of preclinical and clinical progress are presented. These include passive approaches, such as dental implants, and inductive approaches that activate cells with specific molecular signals. PRACTICE IMPLICATIONS: Tissue engineering will have a considerable effect on dental practice during the next 25 years. The greatest effects will likely be related to the repair and replacement of mineralized tissues, the promotion of oral wound healing and the use of gene transfer adjunctively.     

Current update on the diagnosis and management of head and neck soft tissue sarcomas

Head and neck soft tissue sarcomas are a group of rare heterogeneous tumours arising from embryonic mesoderm. They comprise <1% of all head and neck malignancies and 5–15% of all sarcomas with most head and neck sarcomas arising from soft tissues. Although rare, they are associated with both high recurrence and mortality rates. We review the current management of head and neck soft tissue sarcomas.     

脂肪间充质干细胞在颅颌面修复重建中的应用

颅颌面软硬组织缺损是临床常见病和多发病,对患者容貌和功能均有严重妨碍。其修复重建是涉及多学科的综合性临床难题,目前仍有不少问题亟待解决。组织工程的发展为颅颌面修复重建带来了新的思路,而种子细胞来源是组织工程研究的首要问题。近年来,脂肪间充质干细胞因其具有来源广泛、取材方便、诱导条件下多向分化、扩增能力强等优点而成为较为理想的种子细胞。本文就脂肪间充质干细胞在颅颌面修复重建中的应用进展作一综述。     

皮肤软组织扩张术在颌面外科中的应用

目的:总结应用皮肤软组织扩张技术整复外伤、肿瘤及瘢痕切除所致颌面、颈部皮肤软组织缺损的经验。方法:对72例因颌面部瘢痕或洞穿性缺损需软组织修复的病例,采取病变切除前在其附近供区埋置皮肤软组织扩张器,逐次注水扩张,达到设计扩张量后,于切除病变的同期进行缺损整复。结果:72例患者术后随诊6～12月,均效果满意。术后并发症包括感染4例,局部血肿2例,扩张器外露2例,均经对症处理后痊愈。结论:皮肤软组织扩张术应用于颌面颈部皮肤软组织缺损和器官再造,其皮瓣色泽、质地、厚度基本协调、和谐,颜色匹配,有感觉,并可避免邻近组织器官受牵拉变形及供区副损伤,值得临床推广应用。     

天然型无机骨颌面植入体在正颌外科的应用

目的 验证天然型无机骨颌面植入体在正颌外科中应用的有效性。方法 ３０例患有各种颌面畸形的正颌形的正颌外科患者植入了天然型无机骨,植入方式全部为表面贴覆。结果 此种骨代用品具有良好的组织相容性和稳定性,植入手术的并发症少见,软组织改变明显。结论 病例选择合适,天然型无机骨在正颌外科患者中将起到改善面部外科,节省自体骨的目的。     

应用浓缩生长因子促进干细胞增殖及成骨分化修复口腔颌面部缺损的研究进展

浓缩生长因子（concentrated growth factor,CGF）作为最新一代血小板浓缩物,制备方法简单,来源广泛,安全性能高,含有高浓度生长因子,具有柔软纤薄的纤维蛋白网络结构,能够加速组织再生,被广泛应用于修复口腔颌面部软硬组织缺损,并逐渐成为再生医学及组织工程的研究热点。干细胞是一类具有多向分化潜能的细胞,经诱导后可转化为成骨细胞,进而促进骨组织再生。研究证实,CGF可显著促进干细胞增殖及成骨分化。因此,文章就CGF的发展历史、主要成分及作用、在口腔颌面部缺损修复领域CGF对干细胞增殖及成骨分化的作用和总结展望四个方面进行综述,旨在为口腔颌面部软硬组织修复提供新的治疗思路。     

Tissue changes adjacent to titanium plates in patients.

INTRODUCTION: Titanium miniplates are widely used for osteosynthesis in maxillofacial surgery. Titanium is considered to be well tolerated but the long-term effects of titanium retained within human tissues are unclear. AIMS: This study was designed to evaluate histomorphologically the soft tissues adjacent to titanium maxillofacial miniplates and screws in patients, and to determine the nature of pigmented, particulate debris found in the tissues. Materials: Thirty-five soft tissue specimens were excised from the tissues adjacent to titanium miniplates which had been in situ for between 1 month and 13 years. METHODS: All of the soft tissue specimens were prepared for examination under the light microscope. Four specimens were examined under the scanning electron microscope and the transmission electron microscope. Energy dispersive X-ray analysis (EDX) was used to confirm the elemental composition of the particles under investigation. RESULTS: All of the soft tissues showed fibrosis. Pigmented debris was present in 70% of the specimens and titanium was identified by EDX analysis. The debris was predominantly extra-cellular and was not associated with any inflammatory response or giant cell reaction. Fibroblasts were the predominant cell with small aggregates of lymphocytes and scattered macrophages. CONCLUSION: Titanium is apparently well tolerated for up to 13 years.     

Vascularized free bone grafts for maxillary and mandibular reconstruction

Vascularized osteocutaneous free grafts have been successfully applied to maxillofacial reconstruction. Careful planning allows for implant prosthesis fabrication in these cases. The scapula, fibula, and ilium are the donor sites that result in the most favorable application of implant prosthetics. Intraoral soft tissues, although compromised, are manageable with meticulous home oral hygiene practices and frequent recall examinations with professional cleaning. Many patients severely impaired by trauma, neoplasm, or congenital deformity can have restoration of form and function with the amalgamation of microsurgical and osteointegration techniques.     

牙龈间充质干细胞递送支架载体的研究进展

组织工程技术通过利用支架材料、种子细胞、生长因子以达到修复或再生组织器官的目的.支架材料的作用是为种子细胞提供机械支撑并且保护细胞免受体内有害微环境的影响.因此,选择或制备适当的支架材料是组织工程中的关键一步.近年来,将支架材料和牙龈间充质干细胞(gingival mesenchymal stem cells,GMSC...     

Vascularized cranial bone grafts for mandibular and maxillary reconstruction. The parietal osteofascial flap

The authors have performed 13 cases of vascularized cranial bone grafts for reconstruction of maxillofacial defects since 1986. Two types of flaps were used: the parietal osteofascial flap pedicled to the parieto-temporal fascia based on the superficial temporal artery and the temporalis osteomuscular flap pedicled to the temporalis muscle based on the deep temporal artery. Zygomatico-orbital complex, maxilla and mandible were reconstructed and hemifacial microsomia was also treated. The results of vascularized cranial bone grafts pedicled to fascia were as good as those of grafts pedicled to muscle. There were no major complications. Two types of vascularized cranial bone grafts seem to be useful in reconstruction of maxillofacial defects with avascular recipient beds because of their good blood supply. The parietal osteofascial flap has additional advantages including easy rotation of the flap to the defect, particularly a mandibular defect, and versatile use of fascia without bulkiness for reconstruction of soft tissue defects. This flap can be designed as a full- or partial-thickness cranial bone graft with good vascularity. In this paper, our technique for mandibular and maxillary reconstruction using the parietal osteofascial flap is introduced, and the results compared with our temporalis osteomuscular flap technique are reported.