Faculty Bibliography

Large acquired intracranial defects can result from trauma or surgery. When reoperation is required because of infection or tumor recurrence, management of the intracranial dead space can be challenging. By providing well-vascularized bulky tissue, intracranial microvascular free flaps offer potential solutions to these life-threatening complications. A multi-institutional retrospective chart and radiographic review was performed of all patients who underwent microvascular free-flap surgery for salvage treatment of postoperative intracranial infections between 1998 and 2006. A total of six patients were identified with large intracranial defects and postoperative intracranial infections. Four patients had parenchymal resections for tumor or seizure and two patients had posttraumatic encephalomalacia. All patients underwent operative debridement and intracranial free-flap reconstruction using the latissimus dorsi muscle ( N = 2), rectus abdominis muscle ( N = 2), or omentum ( N = 2). All patients had titanium ( N = 4) or Medpor ( N = 2) cranioplasties. We concluded that surgery or trauma can result in significant intracranial dead space. Treatment of postoperative intracranial infection can be challenging. Vascularized free tissue transfer not only fills the void, but also provides a delivery system for immune cells, antibodies, and systemically administered antibiotics. The early use of this technique when intracranial dead space and infection coexist is beneficial

Among surface modifications commercially available for dental implants, the incorporation of bioceramic coatings is one of the most popular. However, concerns regarding the effectiveness of the bond between the metallic Surface and the coating have led to the development of thin-film Ca- and P- based bioceramic coatings. The purpose of this study was to evaluate the early bone response to a thin ion bean deposited (Test) bioceramic implant surface compared to an alumina-blasted/acid-etched (Control) surface in a canine model. Results showed that although no difference in bone-to-implant (BIC) could be noted between the two different surfaces, more organized bone architecture was present around the Test implants in 4 weeks. Based on this observation, the incorporation of a thin- film bioceramic coating positively influenced bone healing around dental implants at early times.

BACKGROUND: Hyalinizing clear cell carcinoma (HCCC) is an uncommon malignant salivary gland tumor that was characterized only recently as a distinct entity. Because of its histologic similarity to several other primary and metastatic tumors and its purported favorable clinical outcome after local resection, it is important to recognize the features of this unusual tumor. METHODS: The authors present 8 new, fully characterized cases of HCCC and systematically reviewed 44 other cases of HCCC reported in the English language literature from 1980 to 2008. Historic cases were reviewed, and available data regarding morphology, special stains, demographics, clinical presentation, radiographic findings, management, and outcomes were extracted. Data from the current series were compared with the earlier published literature. RESULTS: To the best of the authors' knowledge, this was the largest reviewed series of HCCC and included a total of 52 cases. The findings, which included key histologic features, clinical presentation, and outcome, generally were consistent with what was reported previously. However, the current review revealed that 25% of patients reported in the literature had metastatases at initial presentation, including 10 of 44 patients who had metastases to regional lymph nodes and 1 patient who had metastasis to the lung. The authors were unable to identify any specific histologic features that would predict this behavior. CONCLUSIONS: The current results indicated that HCCC is less indolent than was believed previously; therefore, regional lymph node dissection should be considered in conjunction with wide local excision for patients with HCC

The objective of this study was to physico/chemically characterize a commercially available and a newly developed Bioglass and also to evaluate their degradation properties. Materials and Method: Two bioresorbable glasses were utilized, a bioglass synthesized at Chemical Engineering College (University of Sao Paulo, Lorena, Sao Paulo) (BG1), and the other bioglass utilized was Biogran (BG2) (3i Implant Innovations, Brazil). Particles size distribution histograms were developed for both materials, and then they were characterized by Scanning Electron Microscopy (SEM), X-ray diffraction (XR-D) and Fourier Transform Infrared (FTIR) before and after immersion in simulated body fluid (SBF) for 30, 60, and 90 days. Results: The particle size distribution showed that the mean particle diameters at 10%, 50%, and 90% of the total volume were 17.65, 66.18, and 114.71 mu m for BG1, and 354.54, 437.5, 525.00 mu m for BG2. SEM images of BG1 showed that the as-received material had a rough Surface and as the time of degradation elapsed, this surface became smooth. The images of BG2 showed that the as-received material also had a rough surface, and after immersion in SBF, the material's crystalline content/morphology could be observed. The X-ray diffraction recorded that BG1 showed a silica peak, not seen at BG2. FTIR revealed that both bioglasses were of similar composition, except for the CO3-carbonate minor peak, present at the BG2 sample. Conclusions: 1. The particle size distribution showed a polydispersed pattern for both materials. 2. The material Suffered degradation, and the decomposition increased as a function of immersion in SBF. 3. Both bioglasses had similar composition.

The objective of this series of experiments was to evaluate the effect of bioceramic coatings/ incorporations on implant surfaces as a function of implant and surgical drilling design. Methods: A series of four in vivo studies were conducted utilizing the dog proximal tibia model. The models provided implants that remained from 2 to 5 weeks implantation time. The different studies comprised the placement of implants with intimate contact with bone following placement and implant designs that resulted in healing chambers. The various implant types presented surfaces with and without Ca- and P-based bioceramic incorporations. Biomechanical and histomorphometric measurements along with qualitative bone-implant interface morphology evaluation were performed. For all studies, one-way ANOVA at 95% level of significance was employed along with Tukey's post-hoc multiple comparisons. Results: Close contact between cortical and trabecular bone and all the different implant surfaces irrespective of implant fit (with and without healing chambers) showed that all surfaces were biocompatible and osteoconductive. In general, appositional bone healing was observed at all implant regions that were in intimate contact with bone immediately after placement, and an intramembranous-like healing occurred throughout the whole volume of the healing chambers. Irrespective of implant + surgical drilling design, the presence of Ca- and P resulted in a bone morphology that showed primary osteonic structures at earlier times than uncoated surfaces. Conclusion: Irrespective of implant design and surgical drilling combination, the presence of Ca and P on the implant surface positively modulated early healing around endosseous implants.