Guglielmo Ramieri

Sensory endings in skin grafts and scars after extensive burns

Fifteen patients who underwent a split thickness skin graft operation for full thickness burns and six patients with postburn scars were biopsied after a standard aesthesiological examination completed with Weber and Dellon tests. A semiquantitative evaluation was performed on immunohistochemically stained sections to determine the presence or absence of PGP 9.5 immunoreactive intraepithelial fibres, complex sensory receptors, nerve fibres in the dermal papillae, vessel-innervating fibres, gland-innervating fibres, and nerve trunks in the deep dermis. The reinnervation pattern was similar in grafts and scars. With regard to sensory receptors, free nerve endings and Merkel-neurite complexes were observed. Statistical analysis suggested a significant correlation between sensibility and the amount of regenerated nerve structures (particularly in the epidermis and dermal papillae).

Facial soft tissue changes after transverse palatal distraction in adult patients.

This longitudinal study investigated the 3-D facial soft-tissue response to transverse palatal bone-anchored osteodistraction in 18 adult patients. Laser-scanned facial surface data were obtained for all patients before (T(0)), 6 months (T(1)) and 1 year (T(2)) after transverse palatal distraction. The averaged facial morphologies at T(0), T(1) and T(2) were calculated and compared. Sagittal and vertical measurements were obtained from lateral cephalograms to evaluate skeletal and dental movements. Pre- and immediate post-distraction dental casts were used to investigate transverse maxillary movements. Cutaneous changes were mainly observed in the paranasal regions and cheeks, in the range 1-3 mm, reflecting the underlying increase in the maxillary width. A significant enlargement of the nasal base was also demonstrated. The absolute magnitude of these facial changes was limited but clinically relevant. Variable skeletal movements were observed. These were of low magnitude and no systematic tendency could be demonstrated statistically. Significant changes were documented only with regard to orthodontic repositioning of the upper and lower incisors. The mean transverse increases in the maxillary dental arch were 6.7 mm at the intercanine, 6.8 mm at the interpremolar, and 6.1 mm at the intermolar levels.

Characteristics of maxillofacial trauma in females: A retrospective analysis of 367 patients

INTRODUCTION Epidemiological characteristics of maxillofacial injuries are typically reported for male patients, as males represent 70% of the studied population. This retrospective study analysed the aetiology and patterns of maxillofacial fractures in female patients only. MATERIAL AND METHODS A total of 367 female patients, examined between 2001 and 2008, were divided into three age groups (<16, 17-60, and >60 years). Data were collected on aetiology, fracture site, associated lesions, type of treatment, and length of hospital stay. RESULTS The typical female patient presented a mean age of 43 and 25% were over 60 years of age. Falls were the most frequent cause of maxillofacial trauma (43%), followed by motor vehicle accidents (MVAs) (38.7%), assaults (9.3%), sports accidents (6.3%), and other causes (2.7%). The middle third of the face was most frequently affected (53.9%). Associated fractures, mostly orthopaedic and secondary to MVAs, occurred in 23.2% of cases. The over-60 age group had the greatest number of non-operated fractures (27.9%) and the longest mean hospital stay (5.7 days). CONCLUSIONS This study considered only the female population, thereby highlighting epidemiological characteristics of maxillofacial trauma not apparent in the existing literature. Clear distinctions between genders are important for better comparison of data in the future.

Morbidity associated with anterior iliac crest bone graft

OBJECTIVE The aim of this retrospective study was to assess the morbidity of the harvest of the anterior iliac bone graft and the overall satisfaction rates in a group of patients who underwent harvesting of iliac crest bone graft. PATIENTS AND METHODS Patients who underwent iliac crest bone graft procedures from January 2002 to August 2009 were recalled and invited to answer a questionnaire about postoperative pain, sensory disturbance, functional limitations, and cosmetic appearance. RESULTS A total of 61 patients were included in this retrospective study. Seventeen patients (28%) reported postoperative pain. A patient reported an intraoperative hip fracture. Sensory disturbances were reported by 3 patients. CONCLUSIONS Anterior iliac crest can still be considered a favorable donor site for preprosthetic and cleft surgery. Given its relatively low morbidity rate, early ambulation, and hospital discharge, anterior iliac crest still remains the donor site of choice according to the authors.

Immunocytochemical evidence of plasticity in the nervous structures of the rat lower lip

Abstract In this immunocytochemical study we investigated the distribution of nervous structures in the lower lip of adult rats. The region is characterized by a rich cutaneous and mucosal sensory innervation originating from terminal branches of the trigeminal system. Lower lip innervation was investigated by detection of the general neuronal marker protein gene product 9.5 (PGP 9.5) and the growth-associated protein 43 (GAP-43), a neurochemical marker of neuronal plasticity. The entire neural network of both cutaneous and mucosal aspects was stained by the antibody to PGP 9.5. In particular, nerve fibers were observed in the submucosal and the subepithelial plexuses. Thin immunoreactive fibers were observed within the epithelial layers ending as free fibers or as fibers associated with immunopositive Merkel cells. Well-identified anatomical structures receiving sensory or autonomic innervation were also surrounded by PGP 9.5-ir nerve fibers, in particular, hair follicles, vibrissae, glands, and blood vessels. GAP-43-immunostained nerve fibers were observed in all these structures; however, they were generally less numerous than the PGP 9.5-immunoreactive elements. An equal amount of PGP 9.5 and GAP-43 immunoreactivity occurred, in contrast, in the subepidermal and the submucosal plexuses, or in the epidermis and the mucosal epithelium. The present results show that GAP-43 is normally expressed in the mature trigeminal sensory system of the rat. Skin and oral mucosa are characterized by continuous remodeling that may also involve the sensory nervous apparatus. Continuous neural remodeling, regeneration and sprouting may be the reason for the observed expression of GAP-43.

Changes in the density of protein gene product 9.5-immunoreactive nerve fibres in human oral mucosa under implant-retained overdentures

Reduced oral sensitivity and impaired masticatory cycles have been demonstrated in edentulous humans wearing removable dentures, and there is some evidence that these patients have a decreased innervation of the oral mucosa. Clinical and electrophysiological evidence shows that sensory performance improves after oral rehabilitation with implant-retained overdentures. The aim of this study was to compare the density of mucosal innervation in edentulous patients with that in dentate controls and to evaluate changes in the number or type of sensory receptors following placement of endosseous implants in these edentulous individuals. The mucosal innervation was evaluated by immunohistochemical assays for the neurospecific marker protein gene product 9.5, and the innervation pattern was compared with that of dentate controls. Morphometric analysis of the immunohistochemical material demonstrated a decrease in numbers of sensory receptors in the mucosa of edentulous patients and a significant increase in the number of nerve fibres in the mucosa covering the distal edentulous mandibular ridges supporting the prostheses after implant-retained rehabilitation. In contrast, there were only minor increases in the number of nerves in the peri-implant mucosa. These changes in innervation appear to be related either to the new biomechanical situation created by implant support, which favours more physiological tissue conditions, or to an adaptive mechanism in the peripheral processing of sensory stimuli. These changes may explain, at least partially, the clinically observed differences in sensory skills before and after implant placement.

Morphology of corpuscular receptors in hairy and nonhairy human skin as visualized by an antiserum to protein gene product 9.5 compared to anti-neuron-specific enolase and anti-S-100 protein.

The present study elucidates the morphology of encapsulated receptors in human skin by means of immunohistochemistry for the recently characterized neurospecific marker protein gene product 9.5, in comparison with neuronal specific enolase and S-100 protein. Only two types of corpuscles are identified, Meissners corpuscles and simple coiled corpuscles. Moreover, this investigation reveals that though regional specialization may exist with regard to the encapsulated receptor density, the comparison of hairy and nonhairy skin does not reveal important differences.

Golgi-type and immunocytochemical studies on the intrinsic organization of the periventricular layer of the avian paraventricular nucleus

SummaryBy means of the rapid Golgi-impregnation technique, intraependymal nerve cells and CSF-contacting neurons were demonstrated in the periventricular layer of the paraventricular nucleus (PVN) of the Japanese quail, chicken and house sparrow. When immunocytochemistry was applied to the brains of Japanese quail, chicken and Pekin duck these cellular elements displayed vasotocin- and neurophysin immunoreactions. In the present material intraependymal and cerebrospinal fluid-contacting neurons of the paraventricular nucleus (PVN) were never stained with antisera against avian vasointestinal peptide (VIP), corticotropin releasing factor (CRF), angiotensin II and serotonin. The periventricular zone of the PVN comprises conspicuous fiber networks immunoreactive with antisera to neurophysin, vasotocin and CRF. Our results indicate a general morphologic pattern of the above-mentioned peptidergic systems in all avian species investigated, irrespective of their taxonomic position or of certain peculiarities of the habitat and functional adaptation. The present neuromorphological results may provide a basis for further functional analysis of the interrelationships between the compartments containing cerebrospinal fluid and the neuroendocrine hypothalamic centers involved in various autonomic control mechanisms.

Soft tissue changes after orthodontic surgical correction of jaws asymmetry evaluated by three-dimensional surface laser scanner.

Abstract Aesthetic improvement is an essential goal of treatment of facial asymmetry, and it is often difficult to achieve. Reliable three-dimensional measurements are required to support outcome studies. In this study, 15 white adult subjects, 9 females and 6 males, with maxillomandibular asymmetry and malocclusion were studied. The patients were treated with orthodontics and different surgical procedures in single or multiple steps. All patients received double-jaw surgery, except 1 patient who underwent only maxillary osteotomy. Nine of the 15 patients received additional procedures (genioplasty and rhinoplasty) to achieve better symmetry. Posterior-anterior and lateral cephalometry and three-dimensional facial surface data were obtained before (T0) and 1 year (T1) after surgery. Scan data at T0 and T1 were pooled by electronic surface averaging to obtain the mean pretreatment and posttreatment facial model. A symmetric model was constructed by averaging the actual T0 scans and their mirrored models to obtain the virtual optimal symmetric face. Different linear and angular measurements were then calculated for comparison of the mean T0 and T1 models. The normalization of facial proportion and a high increase in symmetry were evident. Residual defects were documented in the postoperative symmetry of the chin. Treatment of facial asymmetry, combined with dental occlusion problems, is still a challenge for maxillofacial surgeons. Orthognathic surgery provides an important improvement of symmetry, but further refinements of technique are still required. Three-dimensional evaluation results in an effective method to support outcome studies on the surgical correction of complex facial deformities.

An Immunohistochemical Study on Cutaneous Sensory Receptors after Chronic Median Nerve Compression in Man

Carpal tunnel syndrome represents the most frequent chronic compressive neuropathy in man and hence may be investigated as a spontaneous model of peripheral nerve damage and repair. In the present report the fate of nerve fibers in the digital skin after long-lasting median nerve compression has been investigated immunohistochemically in comparison to normal digital skin, with special consideration to sensory endings and encapsulated receptors. The presence has been documented of the neurospecific marker PGP 9.5, the glia-associated protein S-100, and the neuropeptides CGRP and CPON which are mainly associated with the sensory and sympathetic nerve fibers respectively. The morphology and distribution of nerve fibers and corpuscles appeared comparable to that of normal digital skin; a reduction in the density of sensory receptors has, however, been observed, although not to the degree that was expected to explain the clinical deficits. It has been also demonstrated that at least part of the CGRP-containing sensory and CPON-containing sympathetic axons may survive unaltered even in patients with a long clinical history of profound sensorial impairment. An apparent discrepancy between the maintenance of nerve fibers and the sensory disturbances and the frequent observation of prompt postoperative recovery even after years of compression results from this investigation. The correlation of immunohistochemical observations and functional scores may not be considered conclusive. It must, however, be discussed if the sensorial impairment in this syndrome might have, at least in some cases, not only an anatomical but also an electrophysiological basis.