Repair of cleft alveolar bone with bioactive glass material using Z-plasty flap
Identifieur interne : 000142 ( Pmc/Corpus ); précédent : 000141; suivant : 000143Repair of cleft alveolar bone with bioactive glass material using Z-plasty flap
Auteurs : Abdelrahman E. M. Ezzat ; Hanna M. El-ShenawySource :
- International Journal of Applied and Basic Medical Research [ 2229-516X ] ; 2015.
Abstract
Multiple literature addresses cleft alveolar bone, with little consensus on the preferred surgical technique. Hence, we described a transoral approach for repair of cleft alveolar bone with Z-plasty and using bioactive glass. Study design: Case presentation and surgical technique description. In conclusion, transoral mucosal repair cleft alveolar bone Z-plasty using bioactive glass demonstrated an alternative easy and simple approach for augmentation of unilateral alveolar cleft patients.
Url:
DOI: 10.4103/2229-516X.165381
PubMed: 26539375
PubMed Central: 4606585
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Repair of cleft alveolar bone with bioactive glass material using Z-plasty flap</title><author><name sortKey="Ezzat, Abdelrahman E M" sort="Ezzat, Abdelrahman E M" uniqKey="Ezzat A" first="Abdelrahman E. M." last="Ezzat">Abdelrahman E. M. Ezzat</name><affiliation><nlm:aff id="aff1">Department of ENT, Faculty of Medicine, Al-Azhar University, Cairo, Egypt</nlm:aff></affiliation></author><author><name sortKey="El Shenawy, Hanna M" sort="El Shenawy, Hanna M" uniqKey="El Shenawy H" first="Hanna M." last="El-Shenawy">Hanna M. El-Shenawy</name><affiliation><nlm:aff id="aff2">Department of Oral Surgery and Medicine, Orodental Division, National Research Center, Cairo, Egypt</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26539375</idno><idno type="pmc">4606585</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606585</idno><idno type="RBID">PMC:4606585</idno><idno type="doi">10.4103/2229-516X.165381</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000142</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000142</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Repair of cleft alveolar bone with bioactive glass material using Z-plasty flap</title><author><name sortKey="Ezzat, Abdelrahman E M" sort="Ezzat, Abdelrahman E M" uniqKey="Ezzat A" first="Abdelrahman E. M." last="Ezzat">Abdelrahman E. M. Ezzat</name><affiliation><nlm:aff id="aff1">Department of ENT, Faculty of Medicine, Al-Azhar University, Cairo, Egypt</nlm:aff></affiliation></author><author><name sortKey="El Shenawy, Hanna M" sort="El Shenawy, Hanna M" uniqKey="El Shenawy H" first="Hanna M." last="El-Shenawy">Hanna M. El-Shenawy</name><affiliation><nlm:aff id="aff2">Department of Oral Surgery and Medicine, Orodental Division, National Research Center, Cairo, Egypt</nlm:aff></affiliation></author></analytic><series><title level="j">International Journal of Applied and Basic Medical Research</title><idno type="ISSN">2229-516X</idno><idno type="eISSN">2248-9606</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Multiple literature addresses cleft alveolar bone, with little consensus on the preferred surgical technique. Hence, we described a transoral approach for repair of cleft alveolar bone with Z-plasty and using bioactive glass. Study design: Case presentation and surgical technique description. In conclusion, transoral mucosal repair cleft alveolar bone Z-plasty using bioactive glass demonstrated an alternative easy and simple approach for augmentation of unilateral alveolar cleft patients.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Witsenburg, B" uniqKey="Witsenburg B">B Witsenburg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yilmaz, S" uniqKey="Yilmaz S">S Yilmaz</name></author><author><name sortKey="Kilic, Ar" uniqKey="Kilic A">AR Kiliç</name></author><author><name sortKey="Keles, A" uniqKey="Keles A">A Keles</name></author><author><name sortKey="Efeoglu, E" uniqKey="Efeoglu E">E Efeoglu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yilmaz, S" uniqKey="Yilmaz S">S Yilmaz</name></author><author><name sortKey="Kilic, Ar" uniqKey="Kilic A">AR Kiliç</name></author><author><name sortKey="Keles, A" uniqKey="Keles A">A Keles</name></author><author><name sortKey="Efeoglu, E" uniqKey="Efeoglu E">E Efeoglu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hallman, M" uniqKey="Hallman M">M Hallman</name></author><author><name sortKey="Cederlund, A" uniqKey="Cederlund A">A Cederlund</name></author><author><name sortKey="Lindskog, S" uniqKey="Lindskog S">S Lindskog</name></author><author><name sortKey="Lundgren, S" uniqKey="Lundgren S">S Lundgren</name></author><author><name sortKey="Sennerby, L" uniqKey="Sennerby L">L Sennerby</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bergland, O" uniqKey="Bergland O">O Bergland</name></author><author><name sortKey="Semb, G" uniqKey="Semb G">G Semb</name></author><author><name sortKey="Abyholm, Fe" uniqKey="Abyholm F">FE Abyholm</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Neo, M" uniqKey="Neo M">M Neo</name></author><author><name sortKey="Kotani, S" uniqKey="Kotani S">S Kotani</name></author><author><name sortKey="Nakamura, T" uniqKey="Nakamura T">T Nakamura</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Johnson, Mw" uniqKey="Johnson M">MW Johnson</name></author><author><name sortKey="Sullivan, Sm" uniqKey="Sullivan S">SM Sullivan</name></author><author><name sortKey="Rohrer, M" uniqKey="Rohrer M">M Rohrer</name></author><author><name sortKey="Collier, M" uniqKey="Collier M">M Collier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kenley, Ra" uniqKey="Kenley R">RA Kenley</name></author><author><name sortKey="Yim, K" uniqKey="Yim K">K Yim</name></author><author><name sortKey="Abrams, J" uniqKey="Abrams J">J Abrams</name></author><author><name sortKey="Ron, E" uniqKey="Ron E">E Ron</name></author><author><name sortKey="Turek, T" uniqKey="Turek T">T Turek</name></author><author><name sortKey="Marden, Lj" uniqKey="Marden L">LJ Marden</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arctander, K" uniqKey="Arctander K">K Arctander</name></author><author><name sortKey="Kolbenstvedt, A" uniqKey="Kolbenstvedt A">A Kolbenstvedt</name></author><author><name sortKey="Aal Kken, Tm" uniqKey="Aal Kken T">TM Aaløkken</name></author><author><name sortKey="Abyholm, F" uniqKey="Abyholm F">F Abyholm</name></author><author><name sortKey="Fr Slie, Kf" uniqKey="Fr Slie K">KF Frøslie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Feichtinger, M" uniqKey="Feichtinger M">M Feichtinger</name></author><author><name sortKey="Zemann, W" uniqKey="Zemann W">W Zemann</name></author><author><name sortKey="Mossbock, R" uniqKey="Mossbock R">R Mossböck</name></author><author><name sortKey="K Rcher, H" uniqKey="K Rcher H">H Kärcher</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Appl Basic Med Res</journal-id><journal-id journal-id-type="iso-abbrev">Int J Appl Basic Med Res</journal-id><journal-id journal-id-type="publisher-id">IJABMR</journal-id><journal-title-group><journal-title>International Journal of Applied and Basic Medical Research</journal-title></journal-title-group><issn pub-type="ppub">2229-516X</issn><issn pub-type="epub">2248-9606</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26539375</article-id><article-id pub-id-type="pmc">4606585</article-id><article-id pub-id-type="publisher-id">IJABMR-5-211</article-id><article-id pub-id-type="doi">10.4103/2229-516X.165381</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Repair of cleft alveolar bone with bioactive glass material using Z-plasty flap</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ezzat</surname><given-names>Abdelrahman E. M.</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>El-Shenawy</surname><given-names>Hanna M.</given-names></name><xref ref-type="aff" rid="aff2">1</xref></contrib></contrib-group><aff id="aff1">Department of ENT, Faculty of Medicine, Al-Azhar University, Cairo, Egypt</aff><aff id="aff2"><label>1</label>Department of Oral Surgery and Medicine, Orodental Division, National Research Center, Cairo, Egypt</aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Abdelrahman E. M. Ezzat, Department of ENT, Faculty of Medicine, Al-Azhar University, Cairo, Egypt. E-mail: <email xlink:href="aemei_ibrahim@yahoo.co.uk">aemei_ibrahim@yahoo.co.uk</email></corresp></author-notes><pub-date pub-type="ppub"><season>Sep-Dec</season><year>2015</year></pub-date><volume>5</volume><issue>3</issue><fpage>211</fpage><lpage>213</lpage><history><date date-type="received"><day>16</day><month>12</month><year>2014</year></date><date date-type="accepted"><day>01</day><month>7</month><year>2015</year></date></history><permissions><copyright-statement>Copyright: © 2015 International Journal of Applied and Basic Medical Research</copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.</license-p></license></permissions><abstract><p>Multiple literature addresses cleft alveolar bone, with little consensus on the preferred surgical technique. Hence, we described a transoral approach for repair of cleft alveolar bone with Z-plasty and using bioactive glass. Study design: Case presentation and surgical technique description. In conclusion, transoral mucosal repair cleft alveolar bone Z-plasty using bioactive glass demonstrated an alternative easy and simple approach for augmentation of unilateral alveolar cleft patients.</p></abstract><kwd-group><kwd>Bioactive materials</kwd><kwd>Bioglass<sup>®</sup></kwd><kwd>cleft alveolar bone</kwd><kwd>mucosal Z-plasty</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>I<sc>NTRODUCTION</sc></title><p>Treatment of the residual alveolar defect in patients with cleft lip and palate often requires bone grafting.[<xref rid="ref1" ref-type="bibr">1</xref>] An important goal for this treatment, apart from restoring the missing alveolar bone in the cleft area, is to obtain favorable periodontal conditions for the teeth adjacent to the defect. Attempts to move the teeth into the edentulous spaces often result in significant periodontal problems.[<xref rid="ref2" ref-type="bibr">2</xref>]</p><p>The first report about the alveolar bone grafting aiming to obtain the continuity of the alveolar process was published by Lexer in 1908,[<xref rid="ref3" ref-type="bibr">3</xref>] who used free bone grafting or pedicled flap of bone and soft tissues of the fifth digit. Various sources of autogenous bone are used, but an anterior iliac crest is considered the gold standard for grafting. Its resorption rate seems to be high within the 1<sup>st</sup> year after grafting.[<xref rid="ref4" ref-type="bibr">4</xref>] From since, multiple techniques and materials have been described to repair the alveolar bone cleft deformity. We describe a transoral mucosal to repair cleft alveolar bone with Bioglass and Z-plasty.</p></sec><sec id="sec1-2"><title>C<sc>ASE</sc> R<sc>EPORT</sc></title><p>A 10-year-old male, born with a unilateral left cleft lip and palate was presented to our clinic. The cleft lip was surgically repaired at an early age. The history indicated that there was no known familial incidence of cleft lip or palate. At the time of the initial dental evaluation, the patient show complete alveolar bone cleft on the left side of the premaxilla with nasolalvelar fistula [<xref ref-type="fig" rid="F1">Figure 1a</xref>]. The patient complained from the nasal regurgitation of both food and fluids into the nose and the disfigurement during a smile.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>(a) Preoperative picture for patient with cleft alveolar. (b) Postoperative picture for patient with repaired cleft alveolar after 1-year</p></caption><graphic xlink:href="IJABMR-5-211-g001"></graphic></fig><p>First, a Z-plasty was designed by donning a Z-incision in the mucosal side of the upper lip forming two mucosal triangles (1 and 2) flap with small mucosal triangle (3) in between [<xref ref-type="fig" rid="F2">Figure 2a</xref>], this small mucosal triangle (3) used to cover the floor of the nose [<xref ref-type="fig" rid="F2">Figure 2b</xref>]. In addition, the bioactive glass (Bioglass<sup>®)</sup> was mixed with blood [<xref ref-type="fig" rid="F3">Figure 3</xref>] and then inserted into the pocket done after the closure of the nasal floor. Finally, the two triangles (1 and 2) are suture together using a 5-0 Vicryl by crossing each other. Wound healing of the recipient sites was observed. Wound complications such as bleeding, infection, dehiscence, and neurologic disturbance were recorded. Furthermore, the evaluation of bone graft quantities was performed according to the Bergland[<xref rid="ref5" ref-type="bibr">5</xref>] scale (Oslo grading system). With this scale, the obtained bone level of the interdental septum is compared with the normal side, and it was type 1 in this case after 1-year [<xref ref-type="fig" rid="F1">Figure 1b</xref>].</p><fig id="F2" position="float"><label>Figure 2</label><caption><p>Intraoperative picture for patient with cleft alveolar. (a) Z-plasty mucosal triangle (1 and 2) flap with small mucosal triangle (3) in between (b) the small mucosal triangle (3) used to cover the floor of the nose</p></caption><graphic xlink:href="IJABMR-5-211-g002"></graphic></fig><fig id="F3" position="float"><label>Figure 3</label><caption><p>(a) Bioactive glass (Bioglass<sup>®</sup>) maples. (b) Bioglass<sup>®</sup> mixed with blood</p></caption><graphic xlink:href="IJABMR-5-211-g003"></graphic></fig></sec><sec sec-type="discussion" id="sec1-3"><title>D<sc>ISCUSSION</sc></title><p>Alloplastic grafts have been used successfully in the repair of artificial alveolar clefts in animals. According to the literature, autogenic grafts are mostly used; however, alloplastic graft material started to take place in repair alveolar clefts in human beings.[<xref rid="ref2" ref-type="bibr">2</xref>]</p><p>Four major categories of surface-active biomaterials have been developed; dense hydroxylapatite ceramics, bioactive glasses, bioactive glass-ceramics, and bioactive composites. Bioactive glass is a commercially available family of bioactive glasses, composed of silicone dioxide (SiO<sub>2</sub>), sodium dioxide (Na<sub>2</sub>O), calcium oxide (CaO) and phosphorous pentoxide (P<sub>2</sub>O<sub>5</sub>) in specific proportions. Bioglass<sup>®</sup> or 45S5 are bioactive glass which is composed of 45% SiO, 24.5% CaO, 24.5% Na<sub>2</sub>O and 6% P<sub>2</sub>O<sub>5</sub>. Bioactive glass such as (e.g., 45S5 or Bioglass<sup>®</sup>) bind to soft tissues and bone, while Bioactive glass-ceramics (e.g., 5S4.3 or Ceravital<sup>®</sup>) bind only to bone, both designed to engender surface reactions that lead to osseointegration,[<xref rid="ref6" ref-type="bibr">6</xref>] In this case I used the bioactive glass (Bioglass<sup>®</sup>).</p><p>Johnson <italic>et al</italic>.[<xref rid="ref7" ref-type="bibr">7</xref>] reported that the bioactive glass material in animals was surrounded with osteoid and new bone. Alloplastic graft materials that provide simply a scaffolding effect to give support to vascular ingrowth and later calcification are known as osteoconductive. Osteoinductive materials, on the other hand, are those that contain morphogens, substances that initiate the development of tissues and organ systems by stimulating undifferentiated cells to convert phenotypically.[<xref rid="ref8" ref-type="bibr">8</xref>]</p><p>Arctander <italic>et al</italic>.[<xref rid="ref9" ref-type="bibr">9</xref>] suggest that one should graft as much bone as possible to obtain adequate facial appearance. Their study examined 18 patients with complete unilateral cleft lip and palate using computed tomography 20 years after secondary cancellous bone graft from the iliac crest. They concluded that, even though all dental gaps were closed, and patients were functionally intact, the amount of alveolar bone in the cleft side was less than that of the noncleft side. Feichtinger <italic>et al</italic>.[<xref rid="ref10" ref-type="bibr">10</xref>] also showed that the absence of adjacent teeth to the cleft site leads to mean the bone volume loss of 95%. Hence, the augmentation of unilateral alveolar cleft could be archived perfect by using this technique and the bioactive glass material, which gave a result of Bergland's scale type 1 after 1-year of follow-up.</p></sec><sec id="sec1-4"><title>C<sc>ONCLUSIONS AND</sc> R<sc>ECOMMENDATION</sc></title><p>Transoral mucosal repair of cleft alveolar bone by Z-plasty using bioactive glass demonstrated an alternative easy and simple approach for augmentation of unilateral alveolar cleft patients. Hence, we recommend more patients to undergo this new technique and a longer time for follow-up.</p><sec id="sec2-1"><title>Financial support and sponsorship</title><p>Nil.</p></sec><sec id="sec2-2"><title>Conflicts of interest</title><p>There are no conflicts of interest.</p></sec></sec></body><back><ref-list><title>R<sc>EFERENCES</sc></title><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Witsenburg</surname><given-names>B</given-names></name></person-group><article-title>The reconstruction of anterior residual bone defects in patients with cleft lip, alveolus and palate. 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