BACKGROUND: Many head and neck surgeons preferred the radiotherapy as a first choice in treating early laryngeal carcinoma(T1, T2) to surgical operation because of the relatively high curability(80-90%), organ preservation and better quality of life. If radiotherapy failed, some surgeons perform total laryngectomy as salvage operation, but others prefer to perform partial laryngectomy, which is increasing in tendency. OBJECTIVE: To investigate the pattern of cancer invasion to the laryngeal cartilages using salvage laryngectomized cancer specimens which had recurred after radiotherapy. MATERIALS & METHOD: Preoperative computerized tomograpy images were retrospectively compared to postoperative salvage laryngectomized cancer specimens which had recurred after radiotherapy 13 cases from March, 1985 to February, 1994. RESULTS: 1) In laryngeal cacer recurred after radiotherapy, incidence of cartilage invasion was not in early supragolttic cancer. but all in advanced supraglottic cancer, and 3cases of 5 cases(60.0%) in early glottic cancer, 4cases of 5 cases(80.0%) in advanced glottic cancer. 2) The order of laryngeal cartilage invasion was the first thyroid cartilage(61.5%), the second arytenoid cartilage(30.7%), and the third cricoid cartilage(23.1%). 3) The diagnostic accuracy of preoperative CT scan for laryngeal cartilage invasion was 66.7% in thyroid cartilage, 55.6% in arytenoid cartilage, 55.6% in cricoid cartilage, and 100% in epiglottis. CONCLUSION: Selection of partial laryngectomy as salvage operation should be considered carefully.
Arytenoid Cartilage ; Cartilage ; Cricoid Cartilage ; Epiglottis ; Head ; Incidence ; Laryngeal Cartilages* ; Laryngectomy* ; Neck ; Organ Preservation ; Quality of Life ; Radiotherapy ; Retrospective Studies ; Thyroid Cartilage ; Thyroid Gland ; Tomography, X-Ray Computed

PURPOSE: The lack of vascularity in the hyaline cartilage is thought to be the main cause of why the cartilage can not repair itself. Therefore, authors designed the reversed intraarticular periosteal flap which preserves the vascular system to the periosteum and assesses neochondrogenesis. MATERIALS AND METHODS: The subjects used were 90 white New Zealand rabbits. Reversed intraarticular periosteal flap, intraarticular periosteal free flap and inducing articular cartilage defect only were performed in 30 rabbits, respectively. We compared the results of each groups according to gross morphology of regenerated tissue, histology and histochemical findings. RESULTS: Reversed intraarticular periosteal flap group and intraarticular periosteal free flap group resulted in better cartilage formation than in the articular cartilage defect only group and the reversed intraarticular periosteal flap group had better results than intraarticular periosteal free flap group even though the difference was not statistically significant. CONCLUSION: The reversed intraarticular periosteal flap was thought to be one of the methods which preserves the vascular system in the process of cartilage regeneration with periosteum.
Cartilage ; Cartilage, Articular ; Free Tissue Flaps ; Hyaline Cartilage ; Periosteum ; Rabbits* ; Regeneration

Chondrocytes isolated from the articular cartilage of rabbit knee joint were cultured in vitro within fibrin glue carrier for 2 weeks. Histochemical and electromicroscopical approaches were used to study chondrocytes behavior and phenotypic expression. In vitro study, chondrocyte assumed a rounded morphology, accumulated metachromatic matrix and took on the cytological characteristics of in vivo cartilage cells. Allogenic cultured chondrocyte in fibrin glue was transplanted into osteochondral defect in rabbit joint. The contralateral knee joint served as a control in which the defect was left empty. This in vivo study was performed for the investigation of the chondrogenic potential of cultured chondrocytes embedded in fibrin glue. Grafted defects was filled with cartilage in gross finding, repaired tissue consisted of differentiated chondrocytes and matrix resumed that of hyaline cartilage. At sixteen week after transplantation, subchondral region was partially transformed into bone without loss of overlying articular cartilage, but in control group, defect did not heal successfully. Repaired articular cartilage was thicker than host cartilage and tide mark was not shown up to 24 weeks. Some of repaired tissue was degraded partially. These results suggest that fibrin glue provides suitable environment for differentiation of chondrocyte and allograft of cultured chondrocyte in fibrin glue transplanted into large osteochondral defect improves cartilage repair.
Allografts ; Cartilage ; Cartilage, Articular ; Chondrocytes* ; Fibrin Tissue Adhesive ; Hyaline Cartilage ; Joints ; Knee Joint ; Rabbits* ; Transplantation ; Transplants*

The chondrogenic potential of free autogenous periosteal grafts for osteochondral defects was investigated at the Department of Orthopaedic Surgery, Yonsei University, Wonju College of Medicine. Five millimeter diameter of circular full-thickness defects were made in patellar groove of both femur in 64 adolescent rabbits and the rectangular periostei, prepared from the proximal tibiae, were placed over the defects of patellar groove and sutured(cambium layer, facing joint surface) and the rabbits were allowed to move actively. A serial gross and histologic examinations of neochondrogenesis were done during 8 weeks. The results were as follows. l. At 2 weeks after operation, neochondrogenesis was hardly seen either in the graft group or in the control group. The defects were partially filled with some fibrous tissue. 2. After 6 weeks of operation, all defects in the graft group(postop 6 weeks and 8 weeks) were filled with hyaline cartilage cells but only 38% (postop 6 weeks) and 44% (postop 8 weeks) of the control group were filled with hyaline cartilage cells. 3. The cartilages, formed at 6 and 8 weeks, were more mature and better than those formed at 4 weeks. 4. The newly formed hyaline cartilage of the graft group filled the defect earlier and were better than those of the control group. 5. The chondrocytes in the newly formed tissue were originated from the cambium layer of periosteal grafts. 6. Free autogenous periosteal grafts can repair a full-thickness defect in a joint surface by producing tissue that resembles articular cartilage grossly and histologically.
Adolescent ; Cambium ; Cartilage ; Cartilage, Articular ; Chondrocytes ; Femur ; Gangwon-do ; Humans ; Hyaline Cartilage ; Joints ; Rabbits ; Tibia ; Transplants

There are many controversies in ability of articular cartilage to heal full thickness defect. Generally, it is reported that full thickness defects of articular cartilage filled with organizing hematoma and granulation tissues, which converted to chondroid tissues. It is clear that the size of defect was related to the repair of articular cartilage. Though cartilagenous material fills the defect and restores the surface continuity, it may undergo degeneration, and lead to localized focus of osteoarthritis. Multiple drilling through subchondral bone could be a kind of treatment in articular cartilage defect. Author conducted an experiment for the full thickness defect of articular cartilage in rabbit. After multiple drilling of articular cartilage, the repair of defect was examined histologically until eighth week. Results were as followings ; l. At lst. week, the defect was repaired by fibrovascular proliferation and granulation tissue. 2. At 3rd. week, hyaline cartilage consisted of normal chondrocyte was formed. 3. At 8th. week, subchondral plste was regenerated completely. 4. All defects that were less than 3 mm. in diameter were healed. More repairs were observed in case with the wider defects if the defects were within 3mm. in diameter. 5. The metachromasia was observed with toluidine blue stain. The reformed cartilage shows slight purple(Grade II) to moderate purple(Grade III) at third week and near normal (Grade IV) at fourth week. In conclusion, multiple drilling may be an effective method of treatment in articular cartilage defect. It is considered that multiple drilling with a 3mm. Steinmann pin may be the most convenient and effective method of the cartilage healing.
Cartilage ; Cartilage, Articular ; Chondrocytes ; Granulation Tissue ; Hematoma ; Hyaline Cartilage ; Methods ; Osteoarthritis ; Regeneration ; Tolonium Chloride

OBJECTIVES: This study aimed to measure the dimensions of the nasal septal cartilage in adult Filipino Malay cadavers and calculate the cartilage area as well as the amount of graft material that can be harvested from the septal cartilage.

METHODS:
Design: Descriptive, cross-sectional
Setting: Pamantasan ng Lungsod ng Maynila College of Medicine Anatomy Laboratory
Subjects: Ten preserved adult cadavers dissected within a period from September 2010 to October 2010. The septal cartilages were harvested and the lengths of the cephalic margin, dorsal margin, caudal margin and ventral margin were measured. From these measurements, the total area of the cartilage and the amount of graft material that can be harvested were calculated.

RESULTS: The mean length of each margin of the septal cartilage was 25.9mm (cephalic edge), 22.3 mm (dorsal edge), 21.4mm (caudal edge) and 33.1 mm (ventral edge). The area of the septal cartilage had a mean value of 652.5 mm². The amount of septal cartilage which can be harvested had a mean area of 403mm².

CONCLUSION: This study showed a slight decrease in septal cartilage area to 652.5 mm² and in available graft material to 403 mm². While this decrease may reflect the apparently smaller noses of native Southeast Asians compared to East Asians and South Asians, the difference in values can also be due to the difference in the number of subjects or in methods of measurement and further studies are recommended to determine the extent of inter-racial variability.

BACKGROUND AND OBJECTIVES: Cancer invasion of the laryngeal cartilage is mainly found in the ossified portion of cartilage and contraindication for conservation surgery of laryngopharyngeal cancer. Thus, it is an important factor to consider in planning the management of laryngopharyngeal cancer. Computed tomographic (CT) scan is an useful tool for the evaluation of laryngopharyngeal cancer, but it is difficult to distinguish cancer invasion from non-ossified cartilage regions by the CT scan. Knowledge of the precise ossification pattern will be useful to determine the cancer invasion of laryngeal cartilage. The purposes of this study include ossi6cation pattern according to age, symmetry of ossification and incidence of bone marrow formation. MATERIALS AND METHODS: Fifty-three cases of normal laryngeal CT scans which were reviewed by two radiologists. They were all males, ranging in the ages from 40 to 69 (mean age 53). Ossification degree (%) was measured from the inferior cornu in the thyroid cartilage and the superior border of the posterior lamina in the cricoid cartilage. Age relation and symmetry of ossification and incidence of bone marrow formation were evaluated. RESULTS: There were no correlation between age and degree of laryngeal cartilage ossification (p> 0.05). But there was symmetry and definite pattern of ossification. Symmetry of ossification was 84.9% in the thyroid cartilage. Incidence of bone marrow formation was 60.6% in the thyroid cartilage and 82.8% in the cricoid cartilage. CONCLUSION: This study reveals that there is no ossification-age relationship, but the symmetry and the definite pattern of ossification in the laryngeal cartilage are useful clues in determining the cancer invasion on CT scan.
Bone Marrow ; Cartilage ; Cricoid Cartilage ; Humans ; Incidence ; Laryngeal Cartilages* ; Male ; Thyroid Cartilage ; Tomography, X-Ray Computed*

PURPOSE: The purpose of this study is to evaluate the effects of recombinant human bone morphogenetic protein-2 (rhBMP-2) after microfracture on the remodeling of subchondral bone and cartilage healing in a model of full-thickness articular cartilage injury in a rabbit. MATERIALS AND METHODS: A full thickness articular cartilage defect of 6x3-mm-size was created in the trochlear groove of the right femur in 24 rabbits. The defect was left empty in six rabbits, and microfracture was done in 18 rabbits. After microfracture, no treatment was done in six rabbits, defect was filled with fibrin glue in six rabbits, and with fibrin glue and rhBMP-2 in six rabbits. The effect of rhBMP-2 after microfracture was evaluated based on histological analysis and real-time polymerase chain reaction (PCR) for analysis of collagen type at 8 weeks after surgery. RESULTS: The score of histological grade scale of six rabbits in which the defect was filled with fibrin glue and rhBMP-2 was better than that of others and real-time PCR also showed a higher amount of collage type 1 and collage type 2 in these six rabbits. CONCLUSION: We consider that fibrin glue and rhBMP-2 after microfracture may accelerate cartilage healing in an articular cartilage defect and maybe helpful in healing the articular cartilage defect into more closely native hyaline cartilage.
Cartilage* ; Cartilage, Articular* ; Collagen ; Femur ; Fibrin Tissue Adhesive ; Humans ; Hyaline Cartilage ; Rabbits ; Real-Time Polymerase Chain Reaction

Because of the extremely limited potential of damaged articular cartilage for either repair or regeneration, and the fact that prosthetic joint replacement is contraindicated for children and young adults due to wear, loosening and mechanical failure of the artificial joint, there is a need for biologieal resurfacing of large, full-thickness defects in diseased or damaged joints by transplantation of a tissue with significant chondrogenic potential. The purpose of this study was to investigate the chondrogenic potential of free intra-articular autografts of the perichondrium or periosteum under the influence of joint motion, to characterize the newly formed cartilage, and to determine which is the more effective method to repair the articular defect. In a rabbit model, rib perichondrium and rib periosteum were used to repair full-thickness defects in the femoral condyle. The newly formed tissue was then evaluated grossly, histologically and histochemically at four, eight and twelve weeks after grafting. Successful grafts of the perichondrium or periosteum proliferate to fill the full-thickness articular cartilage defect with neocartilage which produces glycosaminoglycans in the matrix, as demonstrated by the uptake of saframin O. This production of a large amount of glycosaminoglycans in the reparative tissue is similar to that of hyaline cartilage. Unacceptable results were obtained in 38% of the perichondrial grafts, and in 32% of the periosteal grafts. These failures were due to femoral condyle fractures, and detachment of the grafts or failure of proliferation of the grafts. There was no statistically significant difference between the final results of the perichondrial and periosteal grous(p>0.1). The technique of grafting must be improved to increase the rate of successful grafts in which neocartilage resembling hyaline cartilage fills the articular cartilage defect. The positive results of the present experimental investigation prove that biological resurfacing of full-thickness defects in osteoarthritis, especially of small joints, may be clinically possible through the use of free autogenous perichondrial or periosteal grafts. Such biological resurfacing would be a valuable alternative to prosthetic joint replacement, especially in the treatment of children and young adults.
Autografts ; Cartilage ; Cartilage, Articular ; Child ; Glycosaminoglycans ; Humans ; Hyaline Cartilage ; Joints ; Methods ; Osteoarthritis ; Periosteum ; Regeneration ; Ribs ; Transplants ; Young Adult

Osteochondral lesion is a major joint disease in humans. Therefore, this study was designed to investigate the regeneration of articular cartilage and subchondral bone, using three-dimensional constructs of autologous adipose tissue-derived mesenchymal stromal cells without any biocompatible scaffolds. Mesenchymal stromal cells were harvested by liposuction from seven pigs, isolated enzymatically, and expanded until construct creation. The pig models had two osteochondral defects (cylindrical defects with a diameter of 5.2 mm and a depth of 5 mm) in one of their patello-femoral grooves. A columnar structure consisting of approximately 770 spheroids of 5 × 10⁴ autologous mesenchymal stromal cells were implanted into one of the defects (implanted defect), while the other defect was not implanted (control). The defects were evaluated pathologically at 6 months (in three pigs) and 12 months (in five pigs) after implantation. At 6 months after surgery, histopathology revealed active endochondral ossification underneath the plump fibrocartilage in the implanted defects, but a deficiency of fibrocartilaginous coverage in the controls. At 12 months after surgery, the fibrocartilage was transforming into hyaline cartilage as thick as the surrounding normal cartilage and the subchondral bone was thickening in the implanted defects. The histological averages of the implanted sites were significantly higher than those in the control sites at both 6 and 12 months after surgery. The implantation of a scaffold-free three-dimensional construct of autologous mesenchymal stromal cells into an osteochondral defect can induce regeneration of hyaline cartilage and subchondral bone structures over a period of 12 months.
Adipose Tissue ; Cartilage ; Cartilage, Articular ; Fibrocartilage ; Humans ; Hyaline Cartilage ; Joint Diseases ; Lipectomy ; Mesenchymal Stromal Cells ; Regeneration ; Swine