Management of zygomatic-maxillary fracture (The principles of diagnosis and surgical treatment with a case illustration)

Mechanical trauma to the face may cause complex fracture of the zygoma and the maxilla. The characteristic clinical signs of zygomatic bone fracture include flattening of the cheek, infraorbital nerve paraesthesia, diplopia, and trismus, whereas maxillary fracture may typically cause flattening of the midface and malocclusion. The diagnosis of zygomatic and maxillary fracture should be established with thorough clinical examination and careful radiologic evaluation so that a three-dimensional view of the fractured bones can be obtained. This is essential in order to plan a proper surgical treatment to reconstruct the face in terms of functions and aesthetic. A standard surgical protocol should also be followed in performing the surgical reconstruction of the zygoma and the maxilla. A case of delayed bilateral fracture of zygoma and maxilla is presented here to give illustration on how the principle of diagnosis and surgical treatment of complex zygomatico-maxillary fracture are applied.</span

Healing Mechanism and Osteogenic Capacity of Bovine Bone Mineral—Human Amniotic Mesenchymal Stem Celland Autogenous Bone Graft in Critical Size Mandibular Defect

Experiments on maxillofacial bone tissue engineering showed the promising result; however, its healing mechanisms and effectiveness had not been fully understood. The aim of this study is to compare the bone healing mechanism and osteogenic capacity between bovine bone mineral loaded with hAMSC and autogenous bone graft in the reconstruction of critical size mandibular bone defect. Critical size defects were made at the mandible of 45 New Zealand white rabbits reconstructed with BBM-hAMSC, BBM alone, and ABG, respectively. At the end of first, second, and twelfth weeks, five rabbits from each experimental week were sacrificed for histology and immunohistochemistry staining. Expressions of vascular endothelial growth factor (VEGF), bone mor-phogenic proteins-2 (BMP2), Runx2 and the amount of angiogenesis were analyzed in the first and second week groups, while expressions of Runx2, osteocalcin, collagen type-I fibres, trabecular area and bone incorporation were analyzed in the twelfth week groups. The result showed that expressions of VEGF, BMP2 and Runx2 as well as the amount of angiogenesis were higher in ABG compared with BBM-hAMSC group in the first and second weeks of healing. The result of twelfth week of healing showed that expressions of Runx2 and osteocalcin as well as the thickness of collagen type-I fibres were significantly higher in BBM-hAMSC compared to ABG group, while there was no statistically difference in trabecular area and bone incorporation between BBM-hAMSC and ABG group. This study concluded that early healing activities were higher in auto-genous bone graft than in BBM-hAMSC, while osteogenic activities in the late stage of healing were higher in BBM-hAMSC compared to autogenous bone graft. It was also concluded that the osteo-genic capacity of BBM-hAMSC was comparable to autogenous bone graft in the reconstruction of critical size defect in the mandible

Coen’s ascending ramus fixator use for repositioning the ascending ramus during mandible reconstruction

The aim of mandible reconstruction using reconstruction plate after resection is to restore aesthetic and function for muscles attachment and allow mandible movement during normal function and free from joint problem. Temporomandibular joint (TMJ) is an area of concern during mandible reconstruction using reconstruction plate as misalignment on placing of the reconstruction plate may cause the joint place in distortion to the glenoid fossa. Loss large part of mandible bone structure may lead problems during mandible reconstruction procedure because the surgeon may lose in orientation during forming the reconstruction plate into a horseshoe-shaped form of the mandible as well as during plate placement. The plate can only be well adapted when the position of two distal ends of the resected mandible bone are in a stable position. Simple ascending ramus fixator (CARF) to fix the ascending ramus in its stable original position to allow easy mandible reconstruction was created. Those CARF were designed in two types which have one and two fixator stems used to stabilize one or both sites of the ascending rami and showed its effectiveness.</span

Chondrogenic Differentiation Capacity of Human Umbilical Cord Mesenchymal Stem Cells with Platelet Rich Fibrin Scaffold in Cartilage Regeneration (In Vitro Study)

<p><strong>Background:</strong> Human umbilical cord mesenchymal stem cell is a promising source of allogenous MSC with great chondrogenic differentiation capacity. Meanwhile, platelet rich fibrin (PRF) is a natural fibrin matrix, rich in growth factors, forming a smooth and flexible fibrin network, supporting cytokines and cell migration, thus can be used as a scaffold that facilitate the differentiation of MSC. However, the differential capability of MSC cultured in PRF was still poorly understood. <strong>Method:</strong> We studied in vitro differentiation potential of MSC cultured in PRF by evaluating several markers such as FGF 18, Sox 9, type II collagen, aggrecan in 3 different culture medium. <strong>Result: </strong>The result showed that there was positive expression of FGF 18, Sox 9, type II collagen, aggrecan in all medium of in vitro culture. <strong>Conclusion:</strong> MSC cultured from human umbilical cord had the capacity of chondrogenic differentiation and able to produce cartilage extracellular matrix <em>in vitro</em> which means that hUCMSC is a potential allogeneic MSC for cartilage regeneration.</p

Early Healing Phase In Rat’s Calvarial Critical-Size Defect After Implantation Of Bovine Cortical Membrane

Abstract– Bovine pericardium collagen membrane (BPCM) had been widely used in guided bone regeneration (GBR) for alveolar bone augmentation; but it has prolonged biodegradation characteristic. A newly developed demineralized freeze-dried bovine cortical bone membrane (BCBM) is supposed to have osteogenic induction capacity. Yet, its effect on early bone healing phase needs to reveal. this study attempt to analyse the initial mechanisms of bone defect healing after implantation of BCBM in rat’s calvaria criticalsize defect compared with BPCM. Thirty rats used as samples were divided into 2 groups; the experimental and control group in which BCBM and BPCM were applied over calvaria defects, respectively. Five samples were sacrificed after 3, 5, and 7 days for histology examination using Haematoxylin Eosin (HE) staining. The amount of fibroblast and angiogenesis were counted and statistically analysed using Anova and t-test with significance being p < 0.05. There were no significant differences in the amount of fibroblast in both groups of after implantation on day 3, 5, and 7. There were no significant differences in the amount of angiogenesis between the two groups at 3 and 5 day after implantation (p>0.05), but it was statistically higher than control group (p<0.05) on day 7 post implantation. Bovine cortical bone membrane shows comparable effect on early healing phase of calvaria critical-size defect compared to bovine pericardial membrane. It is, therefore, has potential for use as guided bone regeneration membrane

Identification of Single Nucleotide Polymorphism on Bone Morphogenetic Protein 2 Gene in Non-Syndromic Cleft Lip/ Palate Patient

Cleft lip/palate (CL/P) is one of the most common birth defects in humans. Haploinsufficiency in genes Bone Morphogenetic Protein (BMP) 2 is thought to play an important role in the incidence of CL/P. This study aimed to identify changes in the nucleotide (Single Nucleotide Polymorphism/SNP) BMP 2 rs235768 A>T gene in CL/P patient in Indonesia. Seventy samples of DNA that were successfully amplified and restricted consisted of patient and control samples with the three of which were used for sequencing. Based on the analysis using restriction enzymes and Finch TV and Bioedit software programs, this study identified a change from nucleotide A to nucleotide T which is a mutation missense (Serine-Arginine/TCA-TCT). Based on the results of the Fisher’s exact test, there was difference in genotype frequency between the CL/P group and the control. Meanwhile, there was no difference in allele frequencies between the two groups. The allele frequency T has a higher value than the frequency of the allele A

Chondrogenic Differentiation Capacity of Human Umbilical Cord Mesenchymal Stem Cells with Platelet Rich Fibrin Scaffold in Cartilage Regeneration (In Vitro Study)

Background: Human umbilical cord mesenchymal stem cell is a promising source of allogenous MSC with great chondrogenic differentiation capacity. Meanwhile, platelet rich fibrin (PRF) is a natural fibrin matrix, rich in growth factors, forming a smooth and flexible fibrin network, supporting cytokines and cell migration, thus can be used as a scaffold that facilitate the differentiation of MSC. However, the differential capability of MSC cultured in PRF was still poorly understood. Method: We studied in vitro differentiation potential of MSC cultured in PRF by evaluating several markers such as FGF 18, Sox 9, type II collagen, aggrecan in 3 different culture medium. Result: The result showed that there was positive expression of FGF 18, Sox 9, type II collagen, aggrecan in all medium of in vitro culture. Conclusion: MSC cultured from human umbilical cord had the capacity of chondrogenic differentiation and able to produce cartilage extracellular matrix in vitro which means that hUCMSC is a potential allogeneic MSC for cartilage regeneration.</p

Demineralized Freeze-dried Bovine Bone Xenograft Granules as Alveolar Bone Substitutes: A Profile Study

Implant placement in defective alveolar bone requires bone grafting and autogenous bone graft remains the gold standard bone material, however, it causes donor site morbidities. We explore the profile of newly developed demineralized freeze-dried bovine bone xenograft (DFDBBX). Objective: to assess profiles of DFDBBX granules. Enzymatic protein extraction of DFDBBX were performed and specific growth factors quantified with ELISA. For compatibility study rBM-MSCs was cultured in 2.5%, 5.0% and 10% DFDBBX medium for 72 hours followed by MTT assay. Human adipose-derived MSCs was cultured in conditioned medium of DFDBBX for 2, 7, and 14 days. Expression of RUNX2 and alkaline phosphatase (ALP) were examined by immunofluorescence assay. Data was analysed statistically with significance set at p-value < 0.05. PDGF, VEGF, and FGFa levels of DFDBBX were significantly higher, BMP2 and BMP4 levels were found comparable in both groups, whereas TGF1 significantly lower than FDBBX. Cell viability was comparable between DFDBBX and Deproteinized Bovine Bone Material (DBBM). Runx2 and ALP expression in DFDBBX is equivalent to osteogenic medium group and detected until 14 days. DFDBBX granules contain major proliferative and osteogenic growth factors, not cytotoxic and has osteoinductive properties equivalent to DBBM