Rahul Tandon

Recombinant human bone morphogenetic protein-2 promote and stabilize hard and soft tissue healing for large mandibular new bone reconstruction defects

AbstractNumerous autogenous bone-grafting procedures are available for the recovering of large continuity defects of the mandible. However, these surgical techniques present several limitations involving postoperative morbidity and pain. The development of new bone technique reconstruction not involving autogenous bone graft would offer new opportunities for facial bone reconstruction.This report highlights the possibility of recombinant human bone morphogenetic protein type 2 (rhBMP-2) application without concomitant bone grafting material in the restoration of continuity critical-sized defects after tumor resection in the mandible. The presented case shows a large mandibular reconstruction after tumor removal in a 31-year-old white man affected by ameloblastoma.In this case, the rhBMP-2 application with a carrier consisted on absorbable collagen sponge gives excellent newly formed bone at 18 months of control clinical and radiologic follow-up.The results indicated that the use of rhBMP-2 without concomitant autogenous bone grafting materials in large critical-sized mandibular defects secondary to large mandibular tumor produced excellent regeneration of the treated area.

Immediate distraction osteogenesis: the sandwich technique in combination with rhBMP-2 for anterior maxillary and mandibular defects.

AbstractThe goal of this study was to demonstrate the technique and effectiveness of incorporating recombinant human bone morphogenetic protein-2 (rhBMP-2) to the established sandwich osteotomy technique. Although the success of the sandwich osteotomy procedure has been well documented, we hope to show that the addition of rhBMP-2 will enhance bone formation.We performed a sandwich osteotomy technique in patients who had been treated initially by grafting with suboptimal results. Only defects involving the anterior maxilla (3 patients) or the anterior mandible (1 patient) were included. There were 4 patients, 2 men and 2 women, with an age range of 19 to 62 years. The causes of the ridge deficiencies ranged from pathology to trauma. The height (distance) of distracted transport bone segment was measured. The amount of relapse was measured 6 months after the surgery.All patients exhibited a significant increase in bone height. The amount distracted was 6.75 mm (range, 5–11 mm). The amount of relapse was 8.5% (range, 0%–18%). Dental implants were placed in the reconstructed ridges in all patients. There were no instances of permanent paresthesia. Two patients had exposure of a portion of the hardware, which healed uneventfully.The sandwich osteotomy technique has proven to be an effective method for augmenting deficient alveolar ridges. The addition of rhBMP-2 may aid in its success rate by promoting osteogenesis at the osteotomy site, especially in multiple-operated patients where other traditional techniques have failed to gain the desired ridge height.

Reconstruction of Mandibular Defects Using Bone Morphogenic Protein: Can Growth Factors Replace the Need for Autologous Bone Grafts? A Systematic Review of the Literature

Autogenous bone is still considered the “gold standard” of regenerative and reconstructive procedures involving mandibular defects. However, harvesting of this material can lead to many complications like increasing morbidity, expanding of the surgical time, and incomplete healing of the donor site. In the last few years many authors looked for the development of effective reconstruction procedures using osteoinductive factors without the need for conventional bone grafting. The first-in-human study involving the use of Bone Morphongenic Proteins (rhBMP) for mandibular reconstruction was performed in 2001 by Moghadam. Only few articles have been reported in the literature since then. The purpose of this study was to search and analyze the literature involving the use of rhBMP for reconstruction of mandibular defects. In all the studies reported, authors agree that the use of grown factors may represent the future of regenerative procedures with more research necessary for confirmation.

Osteomas involving the facial skeleton: a report of 2 cases and review of the literature

Osteomas are benign slow-growing tumors. These lesions are essentially restricted to the craniofacial skeleton and rarely diagnosed in other bones. The etiology is often multifactorial. It could be genetic or congenital, (Gardner syndrome) or related to endocrine disorders, chronic inflammatory processes, or traumas. In this work, the authors wanted to illustrate the correlation between the presence of multiple osteomas in the craniofacial skeleton and Gardner syndrome to underscore the importance of the role of the oral surgeon in the early identification of this pathology. Malignant evolution of intestinal lesions arising from Gardner syndrome can be avoided if diagnosed in an early stage. Two significant clinical cases are described and discussed. In the first one, a diagnosis of Gardner syndrome was made after colonoscopy.

Pedicled lingual flap to provide keratinized tissue regeneration over dental implants: a description of the technique and a case report.

The aim of this study is to report the efficacy of a lingual pedicle flap for soft tissue pre-prosthetic surgery in implant rehabilitation. While it has been demonstrated that keratinized gingiva is an important factor for implant success, there remains a dearth of case reports concerning the use of a lingual pedicle flap to achieve this desired outcome in such a large reconstructive effort. For this case report, the patient underwent an anterior mandibular resection of an ameloblastoma and subsequent reconstruction, resulting in soft tissue loss. To satisfy the patients desires, both functionally and esthetically, a bilateral rotated pedicled lingual flap was performed to augment keratinized tissue on the anterior mandibular ridge. An additional vestibuloplasty with two collagen matrices was also performed, and an acrylic splint was then applied to achieve better stabilization. The primary outcome was to evaluate the efficacy of this technique, which, until now, was used only for exposed root coverage. The site demonstrated excellent healing over time, even resulting in an excess of healthy and pink soft tissue, which later had to be corrected with a small gingivectomy. Although the patient reported slight discomfort for a few days after surgery, she was nonetheless pleased both with her ability to function and her appearance. The results of this study show that the bilateral rotated pedicled lingual flap is a viable technique for the correction of soft tissue defects in implant dentistry, providing a good amount of keratinized gingiva.

Closure of large palatal defect using a tongue flap.

AbstractThe aim of this study is to report the effectiveness of a tongue flap for covering a large hard and soft tissue defect following cleft of the palate. A young patient diagnosed with acute lymphoblastic leukemia underwent a surgical reconstruction of the cleft palate by Le Fort I osteotomy and palatal closure utilizing a tongue flap. The flap provided sound and lasting closure after the surgery, and the patient successfully healed. Our goal is to present this unique case and highlight how postoperative results were good, safe, and predictable. We also hope to show that tongue transplantation as flap for hard and soft tissue reconstruction represents a valuable option in reconstruction, given the proper circumstances.

Surgical Treatment of Jacob’s Disease: A Case Report Involving an Osteochondroma of the Coronoid Process

Although it is one of the most common benign tumors of bone in the axial skeleton, the osteochondroma is relatively rare in the maxillofacial region. Its discovery on the coronoid process is even more rare. First described by Jacob in 1899, it remains a rare entity as only a few reported cases have been described in the literature. Nevertheless, the symptomatic features remain relatively nonspecific: limited opening, tightness, and slight expansion of the affected area with or without pain. The demographic features are more established, as it affects younger males. Definitive diagnosis is made after histological analysis, post-resection of the growth. We report a 27 year-old male with a history of limited opening and tightness of the mouth. Computed Tomography (CT) imaging revealed a well corticated exophytic protuberance from the left coronoid process. Left coronoidectomy and excision of the exophytic growth was performed, and was confirmed by histologic analysis to be an osteochondroma, demonstrating Jacobs disease.

Intraosseous inflammatory myofibroblastic tumor in the mandible: a rare pathologic case report.

Inflammatory myofibroblastic tumor (IMT) is an extremely rare lesion found in the maxillofacial region. Its frequency diminishes further when found in the bone. Although classification has varied throughout its history, the histologic features are often diagnostic, particularly with its strong association with anaplastic lymphoma kinase-1 (ALK-1) staining. The current mode of treatment for such a lesion is surgical removal with careful followup. In this rare case report, we describe the diagnosis and treatment in a 16-year-old male. Although this rare pathology can present as—and at times mimic—more serious pathologies, it is important for the attending surgeon to initially manage the pathology conservatively.

Outcome of comminuted mandibular fracture repair using an intraoral approach for osteosynthesis.

Purpose Traditionally, the treatment of comminuted mandibular fractures involves both closed and open reduction. However, modern treatment principles increasingly tend toward open reduction and internal fixation to shorten oro-functional rehabilitation. Although this method increasingly gained popularity to date, a controversy regarding the extraoral versus the intraoral surgical approach still exists. The current study aimed to objectively evaluate the outcome of comminuted mandibular fracture treatment involving open reduction and internal fixation using an intraoral approach. Patients and Methods Consecutive patients treated at the Department of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, between 2005 and 2012 were included. Demographic, presurgical, perisurgical, and postsurgical data were tabulated and statistically evaluated using the &khgr;2 test and the Mann-Whitney U test. Results Forty-five patients could be included. Excellent postoperative results were seen in 84% (38 patients) of the total cohort. Postoperative complications were seen in 16% (7 patients). These 7 patients had the following complications: wound dehiscence (7% [n = 3]), osteomyelitis (7% [n = 3]), abscess development (4% [n = 2]), bone necrosis (2% [n = 1]), and severe nonocclusion (2% [n = 1]). Conclusion Present data showed that the intraoral approach for open reduction and internal fixation in comminuted mandibular fractures represents a comparable surgical technique regarding fracture repositioning and occlusal rehabilitation. Considerably, the risk of concomitant neurovascular damage or even facial scarring, as demonstrated in the extraoral approach, can be neglected by using this technique. Nevertheless, each case has to be judged on its own accord as to which technique can best treat the underlying fracture.

Overexpression of cyclin A in oral dysplasia: An international comparison and literature review.

Oral squamous cell carcinoma (OSCC) is one of the most debilitating cancers in the world and while its causes have been heavily researched, the outcome remains grim. Most of these cancers are identified in the late stage and as a result treatment options are limited. Therefore, researchers have focused their efforts on recognizing and identifying dysplastic tissue that has an increased chance of progressing to cancer. Research has begun to look at cell cycle dysfunctions and in particular, aberrant protein functions as a way of identifying the cellular mechanism at fault. The overexpression of a group of regulatory proteins called cyclins has been demonstrated in many types of dysplasia and carcinomas. Although researchers have identified several different types of cyclins as potential culprits, we chose to focus our study primarily on the overexpression of cyclin A. While most research on oral dysplasia and OSCC has been focused on cyclin D, studies have been done on cyclin A. While the etiology of oral dysplasia/SCC appears to be multifactorial, we chose to compare our results with those of similar studies performed across the globe. The social factors, such as the increased use of tobacco that may have contributed to our results, were compared with similar studies performed in Europe and Asia. While our results were remarkably similar and demonstrated a link between the overexpression of cyclin A in oral dysplasia, there exists some differences and thus may require a multicenter, longitudinal study.