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11 Tissue Engineering as a Minimally Invasive Method
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11.5.3 Extracellular Matrix
Derivatives
The extracellular matrix (ECM) is a tissuespecific meshwork of both structural and functional proteins assembled through a process of
dynamic reciprocity whereby cells both receive
signals from the ECM and contribute to its content and organization. This process is critical to
tissue development and homeostasis. Based upon
these important functions, ECM-based materials
have been used in a wide variety of TE/RM
approaches to tissue reconstruction. It has been
demonstrated that ECM-based materials, when
appropriately prepared, can act as inductive templates for constructive remodeling.
An example of ECM derivatives used for
induction of de novo functional, site-appropriate,
tissue formation was shown by Badylak and others in the use of a scaffold material composed of
porcine-derived ECM configured to mimic the
shape and size of the temporomandibular joint
(TMJ) [17]. This device was implanted in a
canine model of bilateral TMJ discectomy. The
results showed that implantation of an initially
acellular material supported the formation of
site-appropriate, functional host tissue that
resembled that of the native TMJ disc.
Furthermore, this prevented gross degenerative
changes in the temporal fossa and mandibular
condyle. The contralateral controls showed no
tissue formation and had mild to severe gross
pathologic changes of the osseous structures of
the joint [17, 18].
11.6 Endoscopic and Arthroscopic
Techniques for Cell Delivery
in TE/RM
The clinical translation of tissue engineering to
minimally invasive therapies is contingent upon
the development of novel noninvasive endoscopic
and arthroscopic techniques. Bioscaffolds can be
delivered on their own as pure cell homing
devices, or they can be pre-seeded with cells that
can assist in the regenerative process. Cell delivery is particularly important in patient popula-
tions where stem cell populations are inactive or
relatively depleted such as the elderly or
diseased.
The detection, isolation, and sorting of cells
hold an important role in cell therapy and regenerative medicine. Custodio et
monoclonal antibodies against cell surface antigens specific to endothelial cells and stem cells
that were immobilized on the surface of the microparticles [24]. They demonstrated the ability of
biofunctionalized particles to select specific cell
types from mixed cell populations and to promote cell expansion, by using human adipose
stem cells (hASCs) and human umbilical vein
endothelial cells (HUVECs) as examples. The
versatility of this method allows the combination
of the biotin conjugated microparticles with any
biotinylated molecule as antibodies, growth factors, or peptides of interest. They showed that
biodegradable and biocompatible particles functionalized with antibodies presented selective
affinity to cells, making them potentially suitable
for separating subpopulations of cells from complex mixtures. Besides the ability for cell separation, the cultured particles proved to be also
suitable for cell expansion. They were able to
develop an in
easy-to-operate system with the capability to
simultaneously separate and expand different
cells subsets. The aggregation of the functionalized microparticles was shown to successfully
form 3D robust structures upon injection into a
mold. Thus, the developed microparticles demonstrated they might be potentially useful for further studies accomplishing the formation of a
construct in situ upon implantation using minimally invasive procedures.
The minimally invasive delivery of bioscaffolds and cells to a variety of tissue-specific
defect poses will need to be addressed prior to
clinical translation. An example of such an
approach is the study by Subhan et
they developed a technique for minimally invasive and accurate delivery of MSCs in a hydrogel
to augment the nucleus pulposus (NP) in damaged intervertebral discs (IVD) [19]. Their
results demonstrated that the minimally invasive
administration of MSCs in hyaluronan hydrogel
vitro versatile, cost-effective, and
al. developed
al. where
196
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S.A. Hinds and S.E. Feinberg
(HyStem) can successfully augment the repair of
NP in damaged IVD. Ibarra et al. were able to
arthroscopically implant autologous matrixencapsulated chondrocytes in a bioabsorbable
scaffold into the knee for cell-based cartilage
repair. They demonstrated efficacious and reproducible results with a mean of 36 months of follow- up [20]. Leggett and others were able to
utilize gastrointestinal endoscopy to transplant
autologous epidermal cell sheets or seeded
decellularized biological scaffolds to repair
strictures resulting from endoscopic submucosal
resection and circumferential endoscopic mucosal resection. This technique can also be used to
augment the lower esophageal sphincter with the
injection of muscle-derived cells for a novel
potential treatment for gastroesophageal reflux
disease [21].
11.7 Transplantation of Organ
Germs: Salivary Glands
Regenerative tissue engineering techniques have
often drawn inspiration from embryology to
understand and recapitulate the steps involved in
organogenesis. Most organs develop embryologically with reciprocal interactions from at least
two distinct cell layers collectively known as
organ germs. Therefore, there has been an attempt
to bioengineer organ germs for transplantation
that will differentiate and form end organ structures in vivo [22]. Although this technique, pioneered by Takashi Tsuji’s group in Japan, requires
cell harvesting, the transplantation of organ
germs would have minimal surgical morbidity
and therefore may be considered minimally invasive as compared with whole organ transplantation [22].
One potential application for the bioengineered organ germ method is the formation of
salivary glands. Hyposalivation or xerostomia,
frequently associated with a history of head and
neck radiation or autoimmune dysregulation,
can have significant clinical sequela including
tooth decay, impaired mastication, swallowing
dysfunction, and often decreased quality of life.
Current treatment options for xerostomia are
often palliative and insufficient; therefore, the
development of a engineered salivary gland that
responds to gustatory stimulation would have
significant clinical impact. Embryologically
salivary glands develop with reciprocal epithelial and mesenchymal cell interactions resulting in duct and acina formations, which are
the functional unit of salivary glands. Ogawa
et al. demonstrated that a bioengineered salivary gland tissue germ fabricated with isolated
epithelial and mesenchymal cells from mouse
submandibular glands connected with a polygycolic acid monofilament thread guide could be
successfully engrafted in a murine model of
salivary gland defect [23]. The resultant tissue showed morphologic gland formation and
functional amylase positive saliva secretion.
This proof of concept study demonstrates the
utility of bioengineered organ germ development for important clinical problems including
xerostomia.
Conclusions
In situ tissue engineering is a minimally invasive method for the surgical correction of tissue defects or physiologic disease. The
examples discussed in this chapter illustrate
that the implantation of biomaterials with biologic cues can be used to harness the body’s
regenerative capacity through a process of cell
homing of host stem cells from both vascular
and interstitial sources.
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Index
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A
Alveolar distraction osteogenesis (ADO), 105, 106
Anchored disc phenomenon (ADP), 56, 60, 61
Ankylosis, 57
Arthrocentesis
antibiotics, 46
calpain, 46
cartilage proteoglycan components, 46
complications, 46
crystal-induced inflammation, 46
definition, 45
diagnosis, 65
diagnostic and therapeutic value, 46
IgE-containing immune complexes, 46
incidence, 46
interleukin-6, 46
intra-articular fracture, 46
kinins, pain, 46
loading test, 56
local anesthesia, 45
macroscopic diagnosis, 46
matrix metalloproteinase, 46
microscopic analysis, synovial fluid, 46
nasopharyngeal carcinoma, 58
plastic models, 45
prostaglandins, 46
rheumatoid arthritis patients, 46
septic arthritis, hemophilic patients, 46
and splint therapy, 66
succinic acid, 46
symptomatic relief, 45
therapeutic substance, 45
three-way stopcock, 46
thromboxane B, 46
traumatic synovitis, 45
vascular endothelial growth factors, 47
Autoimmune diseases, 122
Autoimmune inflammatory arthritis, 65
B
Bioengineered organ germ method, 196
Biomaterials
extracellular matrix derivatives, 195
hydrogels, 193, 194
shape memory, 194
surgical delivery, 194
Bioscaffolds, minimally invasive delivery, 195
Bone-added osteotome sinus floor elevation (BAOSFE)
Bony ankylosis, 26
Broncho-electroscopes, 9
C
Cell delivery, endoscopic and arthroscopic
Cell homing, 192
Cell therapy, 195
Chronic venous insufficiency, 192
Condylar fractures
D
Deficient alveolar bone, 105, 106
Dental Endoscope, 164, 165
Disc displacement with reduction (DDwR), 52
Disc displacement without reduction
technique, 170
techniques, 195
amoeboid movements, 186
application, 189
devices and in
biomimetic scaffolds, 192
cellular niche, 192
endothelialization, 192
release technology, 192
hematologic stem cells, 188
in situ periodontal regeneration, 189
interstitial stem cells, 186, 188
mobilized intravascular, 186
molecular factors, 186
regulation of, 186
self-healing mechanism, 186 (see also
tissue matrix, 186
tissue-specific architecture, 186
open repair, 75
treatment, 75
vitro design
Tissue engineering)
(DDwoR), 60
© Springer-Verlag GmbH Germany 2018
O. Nahlieli (ed.), Minimally Invasive Oral and Maxillofacial Surgery,
https://doi.org/10.1007/978-3-662-54592-8
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Index
Distraction osteogenesis (DO), 16–18, 100
clinical application, 99
deficient alveolar augmentation, 105
devices, 101
bidirectional, 100
multidirectional, 100
unidirectional, 100
in mandible, 100, 102
in maxilla and midface, 103–105
stages, 100
tension-stress principle, 99
DIVA Smart Implant, 165
Double-puncture arthroscopy technique, 22
Duct avulsion, 139
Ductal stretching technique, 130, 132
Dynamic implant valve approach (DIVA) implants, 165
E
Endoscopic-assisted sinus floor elevation
dynamic implant valve approach, 172, 173
membrane integrity, 172
Endoscopic condylar repairs, 76
anatomic location, 80
Brow retractor, 78
complications, 80
condylar head dislocation, 80
fracture displacement, 80
hemostasis, 77
hitory, 76
Notch retractor, 78
physiotherapy, 80
postoperative Panorex image, 80
screw placement, 78
subcondylar curved elevator, 77
surgical management, 80
threaded fragment manipulator, 78
transcervical technique, 78, 79
transoral approach, 77, 78
transoral vs. transcervical, advantages and
disadvantages, 80
Endoscopic sialolithotomy, 128
Endoscopic sialolithotomy face-lift approach, 133
Endoscopy-assisted intraoral surgery, 125, 128, 130
Endoscopy, implant surgery
assistance, 166
bone conditions, 166
and computerized guided implant surgery, 166
implant site preparation, 166
irrigation procedure, 166
suction, 166
Extracapsular dissection (ECD), 149, 150, 152,
153, 157
blunt dissection, 149
magnification and facial nerve monitoring, 151
preauricular incision, 151
Extracorporeal lithotripter, 124, 125
Extracorporeal shock-wave lithotripsy, 124, 136
and sialoendoscopy, 137, 138
F
Face-lift technique, 134
Fine needle aspiration cytology (FNAC), 150, 151
Frey’s syndrome, 11, 149, 157
G
Gastrointestinal endoscopy, 196
H
Heart valve replacement technologies, 190
Hemarthrosis, TMJ, 64
Horsley-Clarke apparatus, 13
Hydrophilic lubrication, 49
Hyposalivation/xerostomia, 196
I
Ilizarov’s approach, 16
Implantation techniques in dentistry
blind drilling and insertion procedures, 163
bone density and implant stability, 164, 169
navigation equipment, 163
sinus lifting intervention, 164
Interocclusal appliance (IOA), 53
Intraoperative navigation, 12, 13
Intraoral curvilinear distraction devices, 100
Irrigation, sialoendoscopy, 128, 130, 133
J
Juvenile rheumatoid arthritis (JRA), children, 65
L
Large parotid gland pleomorphic
adenoma, 153
Le Fort I osteotomies
complications, 110
endoscopic visualization, 111
insufficient vascularity, 110
maxillary positioning, 115
pterygoid plate fracture, 110
retractors, 111
temporary anchorage device, 113
Lingual nerve paresthesia, 141
Lonsdale-Hill apparatus, 18
Lynch external ethmoidectomy approach, 87
M
Mandibular distraction, 100–102
Maxillary distraction devices, 103, 104
Maxillary sinuses
anatomy, 167, 168
antero-posterior crestal incision, 173
biological role, 167
bone quantity and quantity, 168
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floor elevation
endoscopy and DIVA implants, 170, 171
indications and contraindications, 169, 170
graft placement, 175
and implant insertion, 174, 175
lifting
complications, 175
endoscopic closed sinus elevation, 175
implant insertion and sinus membrane elevation, 176
prosthetic/prosthodontic goal, 179
pterygoid implants, 180
short implants, 179
technical modifications, 171
tilted implants, 180
zygomatic implants, 180
liquid/jelly materials, 175
mucoperiosteal flaps, 175
postoperative care, 175
preoperative planning, 173
presurgical evaluation, 173
second-stage surgery, 175
Maxillofacial surgery, 16
dental implantation procedures, 10
description, 9
endoscopically assisted root canal treatment, 10
implantation surgery, 12
parotid and submandibular sialadenectomy, 10
peroral endoscopy, 9
salivary glands, 10, 11
surgical microscopes, 12
universal non-slipping forceps, 9
McCain triangulation technique, 22
Midface distraction, 103, 104
Minimally invasive (MI) surgery
advantages, 185
Desormeaux endoscope, 5
endoscopic approach, 11
endoscopic self-examination, 10
endoscopy development, 2, 3, 5–7
history of, 1
iatrogenic trauma, 185
Riechert-Mundinger device, 15
stereotactic machine, 14, 15
tricoordinate system, 15
Modular dental endoscope, 164
Modular sialoendoscope, 123
Musculoskeletal (MSK) tissue regeneration, 190
Myofascial pain dysfunction (MPD) syndrome, 23
N
Navigation-assisted Le Fort I osteotomy, 111, 112, 115
Non-calculus-related obstruction, 138, 139
Non-Ilizarov approach, 16
O
Obstructive sialadenitis, 122
One-stage transcrestal-approached surgery, 172
Onlay bone grafts, 180
Operative single-cannula arthroscopy (OSCA), 30–33,
35, 37, 38, 40–43
advantages, 39, 40
arthrocentesis, diagnostic visualization, 32
anterior recess, 35
articular disc, 33
articular eminence, 33
intermediate zone, 35
medial synovial drape, 31
pterygoid shadow, 31, 32
retrodiscal synovium, 32
complications
cranial nerve V/VII damage, 42
fibrocartilage scuffing, 42
glenoid fossa perforation, 43
instrument failure, 43
vessels and hamartosis damage, 43
disadvantages, 39, 40
hand/mechanical instruments, 35
Holmium:YAG laser settings, 29, 37
intra-articular medications
hyaluronic acid, 40
local injection of Botox, 40
platelet concentrates, 41
steroid injection, 40
one-track arthrocentesis, 31, 32
post-OSCA patient management
anesthesia, 41
antibiotics, 41
anti-inflammatory and pain management, 41
liquid diet, 42
spastic perimandibular musculature
contractions, 41
retrodiscal synovium, 39
single- and double-puncture arthroscopy, 29
surgical interventions
anterior release, 37
posterior scarification/contracture, 38
sequential lysis, adhesions, 35
synovectomy, 37
visually guided injection, 35, 36, 40, 41
Operative single-cannula arthroscopy
(OSCA) technique, 22
Orbital blowout fractures (OBFs)
anatomic structures, 84, 85
awake forced duction test, 93, 96
description, 83
disadvantages, 96
endoscopic exploration, 94
endoscopic reconstruction, 89
endoscopic surgical approach, 88, 89
facial fractures, 84
morbidity rates, 83
ophthalmologic evaluation, 90–91
pre-bent titanium mesh, 88
radiological findings, 87
reconstruction materials, 87, 88
surgery indications, 86, 87
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Index
Orbital blowout fractures (OBFs) (cont.)
surgical techniques in management, 87
titanium mesh plate, 91, 92
transcutaneous methods, 93
treatment protocol, 90
two-week algorithm, 87
Orthognathic surgery
description, 109
maxillary fixation sufficiency, 111
real-time navigation systems, 110
virtual surgical planning, 110
Osteogenesis, jaws, 16, 17
Osteotome sinus floor elevation (OSFE), 170
Osteotome technique, 173, 174
P
Parotid gland deep lobe pleomorphic adenoma, 154
Parotid gland pleomorphic adenoma recurrence, 155
Parotid stones, extraoral approach, 132, 133
Parotid surgery
classification, 148
clinical examination, 150
cosmetic impact of treatment, 150
facial nerve palsy, 148
greater auricular nerve, 149
histological classification, 146
history, 146
incidence, 148, 149
modalities progression, 147
nerve dissection, 147
recurrence, 146
rhytidectomy (facelift) incisions, 150
tumour clearance, 148
Parotidectomy variants, 148, 149
Periodontitis, 188–190
Permanent facial nerve palsy (pFNP), 156
Piezoelectric and electrohydraulic devices, 125
Pleomorphic adenomas, recurrence rate, 157, 158
Postoperative gland swelling, 141
Prosthetic rehabilitation, 175
R
Real-time navigation system, 112
Regenerative medicine (RM)
intrinsic cellular processes, 185
self-healing, 185
Release technology, 192
Rigid External Distractor, 104
S
Salivary gland endoscopy
anatomical aspects, 118, 119, 122
facial nerve, 120
lithotripsy equipment and micro-instruments, 117
optical miniaturization, 117
perforation (false rout), 141
ranula, 141
Wharton’s duct, 119
Salivary gland neoplasm classification, 148
Salivary glands disorders, 122
Salivary glands formation, 196
Shock wave unit of Sialowave, 124
Sialadenitis, 122
Sialoendoscopy, 122, 123, 133
of parotid duct, 141
postsurgical complications, 139, 141
removal, stones, 126
Sialolithiasis, 122
approaches, 138
and ESWL, 137, 138
Single-puncture technique, 22
Skin incision technique, 133, 135
Stem cell homing, 188–190
therapeutic tissue regeneration
musculoskeletal defects, 190
periodontitis, 188–190
Stereolithographic model, 113
Stereotaxic approach, 12
Superficial parotidectomy, 146, 148, 151
T
Target-specific biomaterial scaffolding system, 186
Temporary facial nerve palsy (tFNP), 156
Temporomandibular disorders (TMD)
AESCULAP endoscopy system, 28
arthroscopic lavage and lysis, 47
articular disc displacement, 47, 52
assessment, 23
clinical signs and symptoms, 56
diagnosis, 23, 24, 47
non-arthroscopic lysis and lavage, 47
pain and dysfunction, 47
patient management, 25
prevalence, 23
surgical interventions, 47
tragocanthal line, 30
treatment, 25, 26, 47
Wilkes classification system, 24
Temporomandibular joint (TMJ)
architecture, 47
arthrocentesis
clicking joint, 59
clinical examination, 57
complications, 55
contraindications, 55
description, 53
imaging modalities, 57, 59
limited mouth opening, 59
medications, 55
patient-completed questionnaire, 56
patient evaluation, 56
platelet-rich plasma, 55
single-needle cannula method, 55
upper compartment lavage, 55
visual analogue scale, 57
arthroscopy
anatomical description, 22, 23
arthroscopic system, 26
Index
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cannula, 26, 31
chondromalacia, 34
contraindications, 26
diagnosis, 21
graspers and biopsy forceps, 27
indications, 26
lasers, light, 28, 29
medial synovial drape, 33
medical conditions, 26
nomenclature, 21
probe, 27
spinal needles, 28
synovitis, capillary proliferation, 33
condyle remodeling potential, 50
hyaluronic acid, 47
intra-articular pressure, 51
joint integrity, 51, 52
load attenuation, 47, 50
lubrication system, 47
lubricin, 47
osmiophilic layers, embedded vesicular structures, 48
phospholipids, 48
remodeling potential, 47
surface-active phospholipids, 47, 49
Temporomandibular joint osteoarthritis (TMJOA)
chronic inflammation, 62
clinical examination, 62
hemarthrosis, 64
open lock, 64
overloading, 62
symptoms, 62
treatment approach, 62
Tension-stress principle, 16
Tissue engineered heart valve (TEHV), 191
Tissue-engineered venous valves (TEVV), 192
Tissue engineering (TE), 2, 16–18
biologic constructs, 185
biomaterials, 185
cell isolation, tissue biopsy, 186
from embryology, 196
in situ, 196
strategy, 187
Titanium-Aluminum-Vanadium implant, 165
Transalveolar osteotomy, 173, 174
Transillumination technique, 135
Transoral/intraoral surgical approaches, 128
Tunneling technique, 110
V
Valvular heart disease, 190
W
Warthin’s tumours, 151
Wilkes classification, 62
Z
Zernov’s invention, 13
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