Garre's Sclerosing Osteomyelitis is seen primarily in children and young adult and occasionally in older individuals. It is also known as chronic nonsupprative sclerosing osteomyelitis, proliferative periositis of Garre, periostits ossificans. It is commonly associated with carious molar and a history of past toothache. Radiogrphically, a focal area of well-calcified bone proliferation may be seen that is smooth and often has a laminated apperance. This disease is thought to occur because of a low-grade infection or irritation that influence the potentially active periosteum of young individuals to lay down new bone. Its treatment is directed toward removing identifiable source of inflammation. Following successful treatment of dental pathology, remodeling of the mandible generally occurs naturally but the deformity may remain and surgical recontouring may be required. We report a case of Garre's sclerosing osteomyelitis, treated by surgical recotouring and antibiotic therapy, in 9-year old female with literature review.
Child ; Congenital Abnormalities ; Female ; Humans ; Inflammation ; Mandible ; Molar ; Osteomyelitis ; Pathology ; Periosteum ; Toothache ; Young Adult

OBJECTIVEThe purpose of this study is to investigate the osteogenic potential and possibility of combination application of mimetic osteoinductive periosteum with tissue-engineered bone.

METHODSThe three-dimensional construction of tissue-engineered bone was made by implantation of adipose derived stromal cells (ADSCs) into rhBMP-2 mediated bio-derived carrier, and mimetic periosteum was constructed by loading ADSCs into Cs-Col-beta3-TCP with rhBMP-2. 10 mm defects of right radiuses were established in adult New Zealand rabbits, group A was transplanted by tissue-engineered bone with mimetic periosteum, group B was implanted by tissue-engineered bone, and group C was implanted by mimetic periosteum, group D was transplanted by bio-derived compound bone as blank scaffold. X-ray, histology, immunohistochemistry stain, dural energy X-ray absorptiometry (DEXA) and transmission electron microscopy (TEM) examinations were performed at different periods.

RESULTSGroup A played a predominant role in process of new tissue regeneration and mature bone reconstitution, defect completely healed at 12 weeks. Group B showed primary repair, group C also existed in modeling stage. While, group D displayed retard regeneration with poor osteogenic capacity. DEXA result showed that group A had statistical significance over control group according to data of BMC and BMD ( P < 0.05).

CONCLUSIONSEnhanced osteogenic potential can be obtained by using tissue-engineered bone with mimetic osteoinductive periosteum. Defect can be healed with concord pattern of osteoinductive and osteopromotive and osteoconductive effects.

Animals ; Biocompatible Materials ; Bone Regeneration ; Bone Substitutes ; Male ; Periosteum ; Rabbits ; Radius ; pathology ; surgery ; Tissue Engineering ; methods

This investigation was to study the effects of cage-squeezing screw on tendon-bone healing in rabbits. The tendons of Twenty four rabbits were severed and fixed with cage-squeezing screw or ordinary squeezing screw on its tibia, and the interface of tendon-bone was tested at the ends of 3, 6 and 12 weeks after operations, respectively. The cage-squeezing screw can accelerate bone tunel healing and strengthen the graft intension. The experiments proved that the cage-squeezing screw could help the restructuring process of the graft after the beginning of reconstruction.
Animals ; Bone Screws ; Female ; Knee Joint ; surgery ; Male ; Periosteum ; transplantation ; Rabbits ; Tendons ; transplantation ; Tibia ; pathology ; surgery ; Wound Healing

OBJECTIVETo provide experimental data of different oral mucosa suitable to repair denudated palate.

METHODSThirty Japanese white rabbits (5 weeks old) were divided into three groups: I group (left hard palate was denudated with right side intact), II group and III group (both sides of the hard palate were denudated with right side repaired by palatal mucosa or buccal mucosa correspondingly). Then the effect of different transplanted mucosa on preventing maxillary deformity was investigated and compared.

RESULTSMaxillary development in the three groups was same and no significant differences among them were discovered.

CONCLUSIONBuccal mucosa is effective in serving as reparative tissue for preventing maxillary deformity.

Animals ; Cleft Palate ; surgery ; Female ; Maxilla ; abnormalities ; growth & development ; pathology ; Mouth Mucosa ; transplantation ; Palate, Hard ; pathology ; surgery ; Periosteum ; surgery ; Rabbits ; Random Allocation ; Wound Healing

OBJECTIVE: To study application of sternocleidomastoid myoperiosteal flap to reconstruction of the defect of cervical trachea. METHOD: Thirteen hospitalized patients with malignant neoplasm invading cervical trachea and primary tracheal carcinoma were analyzed retrospectively, the sternocleidomastoid myoperiosteal flap was applied to repair the defect of tracheal wall after resection of the neoplasm. RESULT: Among 10 tracheotomy patients, 9 cases were decannulated from 1 month to 5 months. One case needs cannulation because of tracheal stenosis. Three patients with no tracheotomy had no dyspnea after operation. CONCLUSION The sternocleidomastoid myoperiosteal flap is an ideal transplant for cervical tracheal reconstruction.
Aged ; Female ; Humans ; Male ; Middle Aged ; Pectoralis Muscles ; transplantation ; Periosteum ; transplantation ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Surgical Flaps ; Trachea ; pathology ; surgery

OBJECTIVE: To explore the effect of modified pedicled cranial periosteum compound flap in reconstructing the defect of anterior cranial fossa complicated with cerebrospinal fluid leakage. METHOD: Seven nasal and sinus tumor cases with defects and CSF were undertaken reconstructing surgery with the flap, of which 1 was benign and the others were malignancies. The transferred flap pedicled with the frontal branch of the superficial temporal artery and complemented with ipsilateral supraorbital and/or supratraochlear artery. RESULT: All cases healed without failure, one case with adjuvant radiotherapy experienced partial free frontal bone necrosis and healed by ways of drainage through temporal incision. The inner surface of the flap in the nasal cavity was smooth. CONCLUSION Frontal cranial periosteum compound flap have some advantages, such as adequate quantity, good blood supply and easily making,so it can be choose as an important method to reconstruct the defects of anterior cranial fossa and CSF leakage.
Adult ; Aged ; Cerebrospinal Fluid Rhinorrhea ; surgery ; Cranial Fossa, Anterior ; pathology ; Female ; Humans ; Male ; Middle Aged ; Periosteum ; transplantation ; Reconstructive Surgical Procedures ; methods ; Skull Base ; surgery ; Surgical Flaps ; Treatment Outcome

To evaluate the radiological features of osteoid osteoma around lesser trochante of femur, and to analyze the outcomes of treatment with open surgery.
 Methods: From July 2013 to August 2015, 14 patients (9 males, 5 females) with osteoid osteoma around lesser trochanter were retrospectively reviewed. The ages of patients were 9-44 (average 20) years old. The duration of symptom was 3-36 (average 8) months. After the X-ray plain radiography, CT and MR, all patients underwent open resection. No intense exercise was allowed in the first three months after the operation.
 Results: There were 9 cases of cortical type, and 5 cases of subperiosteal type. The niduses were found by plain radiographs in 9 patients. By CT scan, the niduses were found in all 14 patients. The average pre-operative visual analogue scale (VAS) without NSAIDs was 6.5. One month after the operation, the average VAS was 0 for all patients. The follow up time for all patients was 9-34 (average 20) months. No recurrence, infection, neurovascular injury or fracture was found during the follow up.
 Conclusion: Open resection is a feasible method for osteoid osteoma around lesser trochanter of femur with satisfied outcome and low complication rate.
Adolescent ; Adult ; Bone Neoplasms ; complications ; surgery ; Child ; Cortical Bone ; pathology ; Female ; Femur ; pathology ; surgery ; Humans ; Male ; Osteoma, Osteoid ; complications ; surgery ; Pain ; etiology ; surgery ; Periosteum ; pathology ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo confirm if denuded bone on lateral aspects of the hard palate of surgical repairs of the cleft palate is the main reason of causing disturbance of facial growth and to investigate the mechanism.

METHODS48 SD rats were employed in the study. Among them 40 animals were divided into normal control and experimental group randomly. Normal control was not operated. Hard palate mucoperiosteum on the left side in experimental group were excised. Left hard palate mucoperiosteum in another 8 female three-week-old SD rats were excised with same method and were sacrificed at 2nd, 5th, 8th, and 12th day, respectively. The 8 rats were used for histological research.

RESULTSThe width of all left sides hard palates in experimental group was significantly narrower than right side, and demonstrated statistical difference. Chronic osteomyelitis on the denuded hard palate was observed.

CONCLUSIONThe denuded bone wound might be a principal factor for the following maxillary growth deformity in cleft palate patients who received palatoplasty in childhood. The mechanism of causing the deformity might be wound and scar contraction, decreased blood flow and nutrition plus chronic osteomyelitis.

Animals ; Cleft Palate ; surgery ; Female ; Maxilla ; growth & development ; pathology ; Maxillofacial Development ; Mouth Mucosa ; surgery ; Osteomyelitis ; complications ; Palate, Hard ; pathology ; surgery ; Periosteum ; surgery ; Postoperative Period ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Wound Healing

BACKGROUND: Fibrous hamartoma is the key pathology of congenital pseudarthrosis of the tibia (CPT), which was shown to have low osteogenicity and high osteoclastogenicity. This study further investigated the mechanism of impaired osteoblastic differentiation of fibrous hamartoma cells. METHODS: Fibroblast-like cells were obtained from enzymatically dissociated fibrous hamartomas of 11 patients with CPT associated with neurofibromatosis type I (NF1). Periosteal cells were also obtained from the distal tibial periosteum of 3 patients without CPT or NF1 as control. The mRNA levels of Wnt ligands and their canonical receptors, such as Lrp5 and beta-catenin, were assayed using reverse transcriptase PCR (RT-PCR). Changes in mRNA expression of osteoblast marker genes by rhBMP2 treatment were assayed using quantitative real time RT-PCR. Changes in mRNA expression of transcription factors specifically involved in osteoblastic differentiation by rhBMP2 treatment was also assayed using quantitative real-time RT-PCR. RESULTS: Wnt1 and Wnt3a mRNA expression was lower in fibrous hamartoma than in tibial periosteal cells, but their canonical receptors did not show significant difference. Response of osteoblastic marker gene expression to rhBMP2 treatment showed patient-to-patient variability. Col1a1 mRNA expression was up-regulated in most fibrous hamartoma tissues, osteocalcin was up-regulated in a small number of patients, and ALP expression was down-regulated in most fibrous hamartoma tissues. Changes in mRNA expression of the transcription factors in response to rhBMP2 also showed factor-to-factor and patient-to-patient variability. Dlx5 was consistently up-regulated by rhBMP2 treatment in all fibrous hamartoma tissues tested. Msx2 expression was down-regulated by rhBMP2 in most cases but by lesser extent than control tissue. Runx2 expression was up-regulated in 8 out of 18 fibrous hamartoma tissues tested. Osterix expression was up-regulated in 2 and down-regulated in 3 fibrous hamartoma tissues. CONCLUSIONS: Congenital pseudarthrosis of the tibia appears to be caused by fibrous hamartoma originating from aberrant growth of Nf1 haploinsufficient periosteal cells, which failed in terminal osteoblastic differentiation and arrested at a certain stage of this process. This pathomechanism of CPT should be targeted in the development of novel therapeutic biologic intervention.
Adolescent ; *Cell Differentiation ; Cells, Cultured ; Child ; Child, Preschool ; Female ; Hamartoma/complications/*pathology ; Humans ; Infant ; Low Density Lipoprotein Receptor-Related Protein-5/metabolism ; Male ; Neurofibromatosis 1/complications/*pathology ; Osteoblasts/*pathology ; Periosteum/pathology ; Pseudarthrosis/complications/*congenital/pathology/physiopathology ; Receptors, Wnt/metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Tibia/*pathology ; Transcription Factors/metabolism ; Wnt1 Protein/metabolism ; Wnt3A Protein/metabolism ; beta Catenin/metabolism

OBJECTIVETo evaluate the therapeutic effect of bone morphogenetic protein 2 (BMP-2) gene modified tissue engineering bone (GMB) combined with vascularized periosteum in the reconstruction of segmental bone defect.

METHODSAdenovirus carrying BMP-2 gene (Ad-BMP-2) was transfected into the isolated and cultured rabbit bone marrow stromal cells (MSCs). The transfected MSCs were seeded on bovine cancellous bone scaffolds (BCB) to construct gene modified tissue engineering bone (GMB). The bilateral rabbits radial defects (2.5 cm long) were created as animal model. The rabbits were divided into five groups to reconstruct the defects with CMB combined with vascularized periosteum (group A); or GMB combined with vascular bundle implantation (group B); or GMB combined with free periosteum (group C); or GMB only (group D); or BCB scaffolds only (group E). Angiogenesis and osteogenesis were observed by X-ray, histological examination, biomechanical analysis and capillary ink infusion.

RESULTSIn group A, the grafted GMB was revascularized rapidly. The defect was completely reconstructed at 8 weeks. The mechanism included both intramemerbrane and endochondral ossification. In group B, the vascular bundle generated new blood vessels into the grafted GMB, but the osteogenesis process was slow in the central zone, which healed completely at 12 weeks. In group C, the free graft of periosteum took at 4 weeks with angiogenesis. The thin extremal callus was formed at 8 weeks and the repairing process almost finished at 12 weeks. Better osteogenesis was found in group D than in group E, due to the present of BMP2 gene-transfected MSCs. The defects in group D were partial repaired at 12 weeks with remaining central malunion zone. The defects in group E should nonunion at 12 weeks with only fibre tissue.

CONCLUSIONSBMP-2 gene modified tissue engineering bone combined with vascularized periosteum which provides periosteum osteoblasts as well as blood supply, has favorable ability of osteogenesis, osteoinduction and osteoconduction. It is an ideal method for the treatment of segmental bone defect.

Animals ; Bone Marrow Cells ; cytology ; Bone Morphogenetic Protein 2 ; genetics ; Bone Regeneration ; Bone Substitutes ; Bone Transplantation ; methods ; Bone and Bones ; pathology ; Cattle ; Mesenchymal Stromal Cells ; cytology ; Periosteum ; blood supply ; transplantation ; Rabbits ; Surgical Flaps ; blood supply ; Tissue Engineering ; methods ; Tissue Scaffolds ; Transfection