Surgical Results of Canalplasty Using a Pedicled Periosteal Flap for External Auditory Canal Cholesteatoma. We evaluated the outcomes of canalplasty for external auditory canal cholesteatoma (EACC) using an inferior-pedicled periosteal flap to cover the eradicated diseased bone. Retrospective chart review. Tertiary referral center. Thirty-one ears in 30 patients surgically treated for stages III and IV primary EACC. Canalplasty using an inferior-pedicled periosteal flap with or without tympanoplasty. Disease recurrence, hearing, and clinical factors influencing the time taken to achieve complete epithelization of the external auditory canal. The 31 ears with EACC required 2 to 40 weeks (mean, 7.8 wk; median, 4 wk) to achieve complete epithelization. After epithelization, 84% of the ears became
Clinical study on horizontal bone augmentation using an alveolar mucosa-periosteal bone flap. The current study aimed to assess the effectiveness of the alveolar bone mucosa- periosteal bone flap technique in horizontally augmenting the alveolar ridge during dental implant placement. This retrospective analysis included 20 patients with a total of 45 implants, and was designed to evaluate mucosa-periosteal bone flap technique is an effective approach for widening the alveolar ridge while placing dental implants, meriting its consideration for clinical application.
Extensive Periosteal Injury During Fracture Induces Long-Term Pain in Mice. Bone fractures pose a significant public health challenge, often necessitating surgical interventions to facilitate bone healing and functional recovery. Sensory nerve fibers innervate various compartments of the bone tissue, with the periosteum exhibiting the most extensive innervation that is susceptible to injury during trauma. Despite its importance, the effect of injured periosteum on fracture pain remains unknown. This study examines the impact of extensive periosteal injury on fracture pain by using a mouse model. Periosteal injury is induced by mechanical resection during unilateral transverse fracture and compared to transverse fractures with no periosteal injury. Our results demonstrate that extensive
A pedicled buccal periosteal flap for the closure of oro-antral fistula. An oroantral fistula is a communication between the maxillary antrum and oral cavity. This pathological communication is formed mainly due to dental extraction of maxillary premolars and molars. Adequate management should include closing the oroantral fistula and eliminating sinus infections to prevent recurrence and sinusitis. This study aimed to evaluate the effectiveness of using the pedicled buccal periosteal flap for closing an oroantral fistula without changing the native intraoral structure. Patients with oroantral fistulas were included in this study. The patients were examined clinically by Valsalva test and cheek-blowing test, the hole was probed, and the extent of the underlying bone defect was determined
Itm2a expression marks periosteal skeletal stem cells that contribute to bone fracture healing. The periosteum contains skeletal stem/progenitor cells that contribute to bone fracture healing. However, the in vivo identity of periosteal skeletal stem cells (P-SSCs) remains unclear, and membrane protein markers of P-SSCs that facilitate tissue engineering are needed. Here, we identified integral CD34 or Osx, but expressed periosteal markers such as Ctsk, CD51, PDGFRA, Sca1, and Gli1. Itm2a+ P-SSCs contributed to osteoblasts, chondrocytes, and marrow stromal cells upon injury. Genetic lineage tracing using dual recombinases showed that Itm2a and Prrx1 lineage cells generated spatially separated subsets of chondrocytes and osteoblasts during fracture healing. Bone morphogenetic protein 2 (Bmp2
Identification of Postn+ periosteal progenitor cells with bone regenerative potential. Bone contains multiple pools of skeletal stem/progenitor cells (SSPCs), and SSPCs in periosteal compartments are known to exhibit higher regenerative potential than those in BM and endosteal compartments. However, the in vivo identity and hierarchical relationships of periosteal SSPCs (P-SSPCs) remain unclear due to a lack of reliable markers to distinguish BM SSPCs and P-SSPCs. Here, we found that periosteal mesenchymal progenitor cells (P-MPs) in periosteum can be identified based on Postn-CreERT2 expression. Postn-expressing periosteal subpopulation produces osteolineage descendants that fuel bones to maintain homeostasis and support regeneration. Notably, Postn+ P-MPs are likely derived from Gli1
Identification of LRP1+CD13+ human periosteal stem cells that require LRP1 for bone repair. Human periosteal skeletal stem cells (P-SSCs) are critical for cortical bone maintenance and repair. However, their in vivo identity, molecular characteristics, and specific markers remain unknown. Here, single-cell sequencing revealed human periosteum contains SSC clusters expressing known SSC markers supported the preferential expression of LRP1 and CD13 in Prx1+ P-SSCs. When Lrp1 was conditionally deleted in Prx1-lineage cells, it led to severe bone deformity, short statue, and periosteal defects. By contrast, local treatment with a LRP1 agonist at the injury sites induced early P-SSC proliferation and bone healing. Thus, human and mouse periosteum contains unique osteochondrogenic stem cell subsets
Total elbow allograft augmented with vascularized periosteal grafts for salvage of a failed distal humeral joint replacement for Ewing sarcoma reconstruction. Vascularized periosteal grafts have been used to promote bone union in massive bone defects. We present a child with a failed distal humeral joint replacement for Ewing sarcoma reconstruction, successfully treated with a total elbow allograft augmented by vascularized periosteal grafts. V.
Single-nucleus transcriptomics reveal the differentiation trajectories of periosteal skeletal/stem progenitor cells in bone regeneration. Bone regeneration is mediated by skeletal stem/progenitor cells (SSPCs) that are mainly recruited from the periosteum after bone injury. The composition of the periosteum and the steps of SSPC activation and differentiation remain poorly understood. Here, we generated a single-nucleus atlas of the periosteum at steady state and of the fracture site during the early stages of bone repair ( We identified periosteal SSPCs expressing stemness markers ( and /SCA1) and responding to fracture by adopting an injury-induced fibrogenic cell (IIFC) fate, prior to undergoing osteogenesis or chondrogenesis. We identified distinct gene cores associated with IIFCs
A Randomized Controlled Trial Comparing "Early" Versus "Late" Periosteal Patch Attachment to Knee Chondral Defects in Autologous Chondrocyte Implantation. Traditional autologous chondrocyte implantation (ACI) involves arthroscopically harvesting a cartilage biopsy (stage 1), followed by arthrotomy 3 to 4 weeks later to apply a periosteal patch and implant culture-expanded chondrocytes underneath defects, with high levels of patient satisfaction and low failure rates. No evidence was found that applying the periosteal patch at the time of chondrocyte harvest improved long-term Lysholm scores or survival until any re-operation or arthroplasty.
Periosteal block versus intravenous regional anesthesia for reduction of distal radius fractures: A randomized controlled trial We compare periosteal block and intravenous regional anesthesia (IVRA) as anesthetic techniques for reduction of distal radius fractures when performed by emergency department (ED) clinicians following brief training. This was a single-center, nonblinded randomized -assessed ease of the procedure. Eighty-one patients were randomized to receive IVRA (n = 41) or periosteal block (N = 40). Reduction pain scores were not normally distributed. Median (25th-75th percentile) pain scores in participants assigned to IVRA and periosteal block were 5 (1-27.5) and 26 (8.5-63) mm, respectively, (p = 0.007). Use of adjunct medications during reduction was higher
Esthetics and bone changes of immediate implants with or without vascularized interpositional periosteal connective tissue grafting: A 2-year randomized controlled trial. To compare esthetics at single immediately placed implants with and without soft tissue augmentation. Patients with non-restorable maxillary teeth in the esthetic zone were assigned into 2 groups: immediately placed implants with simultaneous vascularized interpositional periosteal connective tissue grafting (VIP-CTG) or non-grafted immediately placed implants (NG). The outcomes included: pink esthetic score (PES), gingival thickness, keratinized tissue width, buccal bone changes, marginal bone loss, pain, and satisfaction. Eighteen implants were included. At 2 years the mean value for PES was 12 ± 3.2 for the VIP-CTG and 12.9 ± 1.3
Evaluation of low-level laser therapy and platelet-rich fibrin on donor site healing after vascularized interpositional periosteal connective tissue flap: a randomized clinical study. To evaluate the effectiveness of platelet-rich fibrin (PRF) and low-level laser therapy (LLLT) on donor site healing after vascularized interpositional periosteal connective tissue (VIP-CT) flap. For the present
Circumferential periosteal block versus hematoma block for the reduction of distal radius and ulna fractures: a randomized controlled trial. To assess the analgesic efficacy of the circumferential periosteal block (CPB) and compare it with the conventional fracture hematoma block (HB). This study was a prospective single-center randomized controlled trial performed in a national orthopedic
Lower eyelid lengthening in facial nerve palsy: when is a periosteal flap required? To present a case series of patients with facial nerve palsy (FNP) undergoing lower eyelid surgery where inadequate horizontal tarsal length was encountered and managed with a periosteal flap. A two-centre retrospective, non-comparative case series of all patients with FNP who underwent lower eyelid periosteal . Unnecessary loss of horizontal tarsal length (particularly during LTS procedures) must be avoided in patients with FNP. Surgeons managing such patients should take care to identify inadvertent eyelid shortening early and be prepared to perform a lateral periosteal flap when required.
Silencing Pulsatile Tinnitus: A Novel Technique of Periosteal Flap Obliteration for Sigmoid Sinus Diverticulum Variants. Review of a sigmoid sinus diverticuli (SSDi) variants surgically managed with a novel technique using an inferior periosteal flap. Case series. Tertiary referral center. Patients presenting with pulsatile tinnitus to a tertiary referral center between January 1, 2015, and June 31, 2021, who were diagnosed with SSDi variants on CT temporal bone and who received surgical management for these SSDi variants. Obliteration of SSDi variants using a novel technique with an inferiorly based periosteal flap. Pure-tone audiometry, Tinnitus Handicap Inventory score, and visual analogue scale score for tinnitus severity (loudness, awareness, annoyance, and effect on life). Include
Clinical evaluation of periosteal pedicle flap in the treatment of gingival recessions for esthetic root coverage: A randomized controlled clinical trial. Root coverage using subepithelial connective tissue graft (SCTG) is gold standard with few drawbacks such as requirement of second surgical site, reduced donor tissue availability, and increased surgical complications and pain. Periosteal
Periosteal Nerve Block Vs. Intravenous Morphine in Pain Relief of Distal Radius and Ulna Fracture; a Double-Blind Randomized Clinical Trial. Distal forearm fractures' realignment and fixation is a painful procedure. This study aimed to compare the efficacy of periosteal nerve block and intravenous morphine in distal radius and ulna fractures' pain management. In the present randomized, parallel , double-blind, controlled clinical trial, patients with distal radius or ulna fractures were divided into two groups. In the first group, for periosteal nerve block, 1% lidocaine was injected at a distance of 6 to 8 cm near the wrist from the lateral radius and medial ulna. In the second group, morphine sulfate at a dose of 0.1 mg/kg was slowly injected through the peripheral vein within 5 minutes
Endochondral Repair of Jawbone Defects Using Periosteal Cell Spheroids. Recapitulation of the natural healing process is receiving increasing recognition as a strategy to induce robust tissue regeneration. Endochondral ossification has been recognized as an essential reparative approach in natural jawbone defect healing. However, such an approach has been overlooked in the recent development