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Background: Autologous costal grafts are used universally in clinical practice for rhinoplasty and reconstruction. However, surgeons worldwide have not agreed on the details of graft harvesting, including rib selection, side preference, operation mode, cutting methods, and handling of the periosteum and perichondrium. This study aimed to provide an overview of the novel techniques used for auto-rib harvesting in rhinoplasty within the past 5 years and identify potential avenues for future research. Methods: We searched for related articles in PubMed, Embase, and Web of Science from 2019 to 2023, summarized crucial but controversial steps in recent practice, and analyzed their theoretical basis and clinical feasibility. Results: Auto-rib and cartilage open harvest is still mainstream in rhinoplasty and reconstruction, with the 5th to 8th ribs and cartilage being the most used. The laparoscopic harvest is gaining attention, being second only to the open harvest, with the 9th/10th ribs and cartilages being particularly convenient. The clinical applications of full-cut and split-cut methods differ in their advantages. Except for some special reasons, almost all studies tended to preserve the periosteum and perichondrium in situ, and few surgeons chose to harvest the grafts on the left side. Conclusion: Multiple techniques have emerged, requiring surgeons to balance the benefits and risks of various strategies at each step. New theories and techniques should be fully tested promptly and in clinical practice before wide application. Overall, a professional consensus is needed for better directivity, precision, and stability in clinical practice.

Background: Previously a techniques variety have been described and are currently utilized in tympanoplasty type 1, involving sandwich, underlay, overlay, plugging, rosette and pegging. The operative material and technique choice for tympanoplasty persists controversial. Aim: We aimed to evaluate the wheel-shaped cartilage-perichondrium composite graft and functional and anatomical outcomes of ring in endoscopic tympanoplasty type I for repairing of large and subtotal perforation. Methods: This prospective comparative study was carried out on fifty chronic suppurative otitis media patients tubotympaic type with large and subtotal tympanic membrane (TM) perforation. The participants were assigned randomly into two groups: Group A included 25 patients who were subjected to endoscopic tympanoplasty type 1 ringshaped composite cartilage perichondrium graft. Group B contained 25 patients who were subjected to endoscopic tympanoplasty wheel-shaped composite cartilage-perichondrium graft. Results: Post-operative pure tone audiometry (PTA) test in ring-shaped graft group was 20.2 ± 2.5, while in wheelshaped graft group was 19.36 ± 2.53 with no statistically significant difference (p= 0.244) between the two groups. Conclusion: Our study found that while both ring and wheel-shaped cartilage-perichondrium composite grafts can achieve successful graft acceptance, the wheel-shaped graft showed a significantly greater postoperative improvement in hearing outcomes, a higher rate of TM regeneration, and comparable graft success rates. Additionally, the choice of graft shape played a pivotal role in optimizing surgical outcomes, particularly in cases with significant perforation size. Our study highlighted the potential advantages of wheel-shaped grafts in enhancing hearing improvement and TM regeneration for patients with CSOM. [ABSTRACT FROM AUTHOR]

Objective: To investigate MRI findings in children with physeal fractures of the knee with respect to age, location, and articular involvement. Methods: Children with physeal fractures who underwent knee MRI between 2008 and 2021 were included. Two radiologists retrospectively reviewed all examinations to determine articular involvement, findings of physeal instability (perichondral disruption, periosteal entrapment), and internal derangement (cruciate ligament injury, meniscal tear, chondromalacia). Independent samples t, Mann–Whitney U, Pearson's chi-square, and Fisher's exact tests were used to compare findings. Results: Fifty-six patients (37 boys, 19 girls; mean age: 12.2 ± 2.5 years; 32 distal femur, 24 proximal tibial fractures) included 24(43%) intraarticular fractures. Fractures were more common in the tibia than the femur (67% versus 25%, p = 0.004) and intraarticular fractures were more common in older than younger children (13.1 ± 2.0 versus 11.5 ± 2.7 years, p = 0.01), to associate with chondromalacia (46% versus 12%, p = 0.02) and undergo surgery (33% versus 10%, p = 0.04) when compared to extraarticular fractures. Perichondral disruption (n = 44, 79%) and periosteal entrapment (n = 13, 23%) did not significantly differ based on location or articular involvement (p > 0.05). At a median follow-up of 17.5 months (interquartile range: 1.25–34), 3 patients (2 intraarticular, 1 extraarticular fractures) developed osteoarthritis, osteochondral lesion, and leg-length discrepancy from growth arrest, which required additional surgery. Conclusion: Intraarticular physeal fractures were more common with older children, associate with chondromalacia, and underdo surgical intervention when compared to extraarticular fractures of the knee. While MRI findings of physeal instability were common, no significant differences were found between fractures based on anatomic location or fracture pattern. [ABSTRACT FROM AUTHOR]

The attachment of the palatopharyngeus extended from the posterior end of the thyroid cartilage to the posterior margin of the inferior constrictor attachment that might contribute to successive swallowing movements. Laryngeal elevation is essential for proper swallowing and breathing. Recently, clinical research has demonstrated that the palatopharyngeus, a longitudinal muscle of the pharynx, is involved in the elevation of the larynx. However, the morphological relationship between the larynx and palatopharyngeus remains unclear. In the present study, we analyzed the attachment site and characteristics of the palatopharyngeus in the thyroid cartilage. We evaluated 14 halves of seven heads from Japanese cadavers (average age: 76.4 years); 12 halves, anatomically and two halves histologically. A part of the palatopharyngeus, which originated from the inferior aspect of the palatine aponeurosis, was attached to the inner and outer surfaces of the thyroid cartilage through collagen fibers. The attachment area extends from the posterior end of the thyroid cartilage to the posterior margin of the attachment site of the inferior constrictor. The palatopharyngeus may elevate the larynx with the suprahyoid muscles and contribute to successive movements of swallowing with surrounding muscles. Based on our findings and previous studies, palatopharyngeus with various muscle bundle directions may be essential for the coordination of continuous swallowing events. [ABSTRACT FROM AUTHOR]

To compare results of inlay and overlay cartilage-perichondrium composite graft myringoplasty. The present study was conducted in the department of otorhinolaryngology, Pt. B. D. Sharma PGIMS, Rohtak. The study was conducted on 40 patients of either sex in age group of 15–50 years having unilateral or bilateral inactive (mucosal) chronic otitis media with dry ear over a period of at least 4 weeks without use of topical or systemic antibiotics after obtaining their informed and written consent. Mean age in group I was 25.25 ± 7.27 years and in group II was 25.95 ± 9.06 years. Maximum number of patients in both groups were in the age group 15–24 years. Out of the total patients, 60% were males and 40% were females. At 6 months post operatively, 95% cases in group I had successful graft take-up compared to 85% cases in group II. However, at long term follow up for 24 months, graft success rate was statistically significant in group I. In group I, 100% graft uptake was seen in large size perforation of 4 and 5 mm along with 2 mm as compared to group II, with 100% graft uptake for only small size perforation of 2 mm. The mean hearing threshold gain was 16.50 ± 5.52 dB in group I as compared to 13.03 ± 6.44 dB in group II. Mean postoperative improvement in air bone (AB) gap of 16.50 ± 5.52 dB was seen in group I as compared to 13.07 ± 6.44 dB seen in group II. The graft take up rate was found to be better in long term with inlay cartilage- perichondrium composite graft myringoplasty technique compared to over lay technique with both the groups showing significant hearing improvement post-operatively. This high success rate for graft uptake and ease to perform under local anaesthesia makes in-lay cartilage perichondrium composite graft myringoplasty technique relatively optimal to use for office based myringoplasty. [ABSTRACT FROM AUTHOR]

Abstract Background Reconstruction of an osteoarthritic distal radioulnar joint (DRUJ) in patients with high physical demands and a long lifetime expectancy is challenging. A variety of methods like implant surgery and salvage procedures as partial or total ulnar head resection and the Sauve-Kapandji procedure are reasonable options in the elderly patient but not in young individuals since it often compromises manual power and stability and may cause impingement problems. Reconstruction of the DRUJ with rib perichondrium is a new treatment option with promising short-term outcome. The aim the present study was to investigate if the outcome is consistent over time. Methods Four female patients with a mean age of 40.5 years suffered severe unilateral osteoarthritis in the DRUJ. They underwent reconstruction of the joint with rib perichondrium transplants. Preoperatively, mean pain under manual load was 8.5 (range 7–10) and 4.2 (range 2–5) at rest, using the visual analogue scale (VAS). Range of motion (ROM) in forearm rotation was on average 118° and grip strength was 86% in comparison to the contralateral hand. The outcome was assessed at a clinical follow-up in 2016, measuring ROM, grip-strength, pain at rest and under manual load and DASH-score. Radiological examination was performed. An additional follow-up by letter was performed in 2021 using a patient-reported-outcome survey (PROS). The patients were asked to grade the ROM and grip-strength as changed or unchanged in comparison to the clinical follow-up in 2016. Results At clinical follow-up at a mean of 3.1 years (range 1–5) after surgery, pain level had decreased to VAS 1.5 (0–5) under load and all patients were pain free at rest. Forearm rotation was on average 156° (range 100–180) and grip strength was 97% of the unoperated hand. The mean DASH-score was 14.4 (0–45). An additional follow-up by letter was conducted at a mean of 7.5 years (5.5–9.5) after surgery. ROM and grip strength were reported as unchanged by all patients in relation to the previous clinical follow-up. No additional surgery or complications were reported. Conclusion Reconstruction of the osteoarthritic DRU-joint with rib perichondrium transplantation can provide good clinical outcome with perseverance over time. Level of evidence IV.

Damaged hyaline cartilage gradually decreases joint function and growing pain significantly reduces the quality of a patient's life. The clinically approved procedure of autologous chondrocyte implantation (ACI) for treating knee cartilage lesions has several limits, including the absence of healthy articular cartilage tissues for cell isolation and difficulties related to the chondrocyte expansion in vitro. Today, various ACI modifications are being developed using autologous chondrocytes from alternative sources, such as the auricles, nose and ribs. Adult stem cells from different tissues are also of great interest due to their less traumatic material extraction and their innate abilities of active proliferation and chondrogenic differentiation. According to the different adult stem cell types and their origin, various strategies have been proposed for stem cell expansion and initiation of their chondrogenic differentiation. The current review presents the diversity in developing applied techniques based on autologous adult stem cell differentiation to hyaline cartilage tissue and targeted to articular cartilage damage therapy. [ABSTRACT FROM AUTHOR]

Santiago Ramón y Cajal (1852-1934), a distinguished histologist and Nobel Laureate in Physiology or Medicine in 1906, is considered the father of Neuroscience. However, his legacy also extended to the study of various tissues, including hyaline cartilage, an area in which he was a pioneer. Throughout his work Elements of Normal Histology and Micrographic Technique, Cajal developed fundamental concepts that, when reviewed in light of molecular biology, resonate with current ideas about cellular communication and macromolecular interactions. In particular, his observations on hyaline cartilage, such as stellate chondrocytes, were largely overlooked in the scientific literature until today. In this paper, four hypotheses based on his discoveries are proposed: the architecture of chondrocyte columns, the role of the perichondrium in endochondral ossification, cartilage nutrition, and the role of the Golgi apparatus in the resting zone. Nearly a century later, research on hyaline cartilage continues to confirm Cajal's pioneering ideas., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)

Introduction: The use of the endoscope in otological surgeries has both diagnostic and therapeutic values. It provides an excellent view in difficult nooks and corners. The use of endoscopic sandwich myringoplasty using cartilage and perichondrium has its benefit in hearing outcome and graft uptake in long-term follow-up. The main objective was to compare the long-term with short- term hearing outcomes in those who have undergone endoscopic sandwich myringoplasty with Dhulikhel hospital (D‑HOS) technique. Materials and Methods: Forty-two patients who underwent endoscopic sandwich myringoplasty with D-HOS technique using tragal cartilage perichondrium were enrolled in the study. The hearing outcome was analyzed by comparing the pre-operative findings with post-operative findings and amongst post-operative patients, long-term with short-term air bone gap (ABG) and ABG closure in speech frequencies (0.5kHz, 1kHz, 2kHz, 4kHz) were compared. Results: Amongst forty-two patients, 40 (95.2%) had graft uptake in both short-term (6.08 months) and in long-term (20 months) follow-up. The mean pre-operative ABG was 28.1±9.3dB whereas the mean short-term post-operative ABG was 14.5±7.2dB, it showed statistical significance (P=0.001). Likewise, while comparing pre-operative with long-term post-operative ABG (13.4±4.8 dB), it showed statistical significance of P=0.000. While comparing short-term with long-term post-operative ABG, it did not show any statistical significance (P=0.065).The mean closure in ABG in both short-term and long-term hearing assessment was not statistically significant (P=0.077). Conclusion: Endoscopic sandwich myringoplasty with D-HOS technique is a reliable procedure with good hearing outcome and graft uptake in both short and long-term follow-up.

Background: Reconstruction of an osteoarthritic distal radioulnar joint (DRUJ) in patients with high physical demands and a long lifetime expectancy is challenging. A variety of methods like implant surgery and salvage procedures as partial or total ulnar head resection and the Sauve-Kapandji procedure are reasonable options in the elderly patient but not in young individuals since it often compromises manual power and stability and may cause impingement problems. Reconstruction of the DRUJ with rib perichondrium is a new treatment option with promising short-term outcome. The aim the present study was to investigate if the outcome is consistent over time.Methods: Four female patients with a mean age of 40.5 years suffered severe unilateral osteoarthritis in the DRUJ. They underwent reconstruction of the joint with rib perichondrium transplants. Preoperatively, mean pain under manual load was 8.5 (range 7-10) and 4.2 (range 2-5) at rest, using the visual analogue scale (VAS). Range of motion (ROM) in forearm rotation was on average 118° and grip strength was 86% in comparison to the contralateral hand. The outcome was assessed at a clinical follow-up in 2016, measuring ROM, grip-strength, pain at rest and under manual load and DASH-score. Radiological examination was performed. An additional follow-up by letter was performed in 2021 using a patient-reported-outcome survey (PROS). The patients were asked to grade the ROM and grip-strength as changed or unchanged in comparison to the clinical follow-up in 2016.Results: At clinical follow-up at a mean of 3.1 years (range 1-5) after surgery, pain level had decreased to VAS 1.5 (0-5) under load and all patients were pain free at rest. Forearm rotation was on average 156° (range 100-180) and grip strength was 97% of the unoperated hand. The mean DASH-score was 14.4 (0-45). An additional follow-up by letter was conducted at a mean of 7.5 years (5.5-9.5) after surgery. ROM and grip strength were reported as unchanged by all patients in relation to the previous clinical follow-up. No additional surgery or complications were reported.Conclusion: Reconstruction of the osteoarthritic DRU-joint with rib perichondrium transplantation can provide good clinical outcome with perseverance over time.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Objective: To compare the rate of graft uptake and postoperative hearing outcomes of Type I tympanoplasty with perichondrium reinforced cartilage palisade to temporalis fascia for large tympanic membrane (TM) perforations over 5 years follow-up period. Materials and methods: This was a retrospective comparative study involving patients with chronic otitis media with large TM perforations. The patients underwent type I tympanoplasty using either perichondrium reinforced cartilage palisade (CP group) or temporalis fascia (TF group) as the graft via a transmeatal approach and under local anesthesia. Morphological and functional results were recorded at three- and five years follow-up. Demographic profiles including age and sex, surgery side, contralateral disease and graft uptake rate, as well as hearing outcomes, were compared between the two groups. Results: At three years follow-up, graft uptake was 94.87% for perichondrium reinforced cartilage palisade and 80.7% for fascia, respectively, (p = 0.67). At five years follow-up, the uptake rate dropped to 87.17% in the CP group, but to 66.6% in the TF group (p=0.019). Hearing improved after surgery in both groups, and showed no significant difference between the two groups. Conclusion: Over long-term, perichondrium reinforced palisade showed a statistically significant better outcome regarding graft uptake than temporalis fascia in type Itympanoplasty for large TM perforations with comparable audiometric results

Objective: Cartilage grafts are widely used in reconstructing nasal deformity for structural and aesthetic purposes. Despite being immunologically privileged, cartilage grafts are susceptible to volume loss with high risk of resorption over time. Therefore, experts opt for cartilage handling modification to resolve this issue through graft dicing, wrapping, or perichondrium preservation. This study will evaluate the effect cartilage graft preparations on graft viability. Design: Single-randomized post-test-only study design. Setting: Animal Hospital at Bogor Agricultural Institute. Participants: Six New Zealand, male, Hycole rabbits. Intervention: Conchal cartilage grafts were retrieved from 6 experimental rabbits and distributed into 3 treatment groups: diced cartilage graft (DC; control), one-sided perichondrium-attached scored cartilage (OPSC), and tube-shaped perichondrium-wrapped diced cartilage (TPDC). Main Outcome Measures: Macroscopic (weight and contour) and microscopic (chondroblast proliferation, graft thickness, apoptotic cells) evaluation through histological measures were recorded on week 12. Statistical analysis was done to compare between groups. Results: Diced cartilage and OPSC groups showed significant weight changes on week 12 (P <.05) with OPSC presenting with the biggest difference. Diced cartilage and OPSC group showed moderate cell proliferation on week 12 while TPDC displayed most abundant apoptotic cells (5.8%; P <.05). Diced cartilage group had the highest cartilage thickness ratio (P <.05). Discussion: Bare DC technique promoted graft thickness while perichondrium-attached scored cartilage showed the most abundant chondroblast proliferation and the least apoptotic cells. Perichondrium contributes to enhanced new cartilage formation. Conclusion: Diced cartilage graft is suitable for masking irregularity and volume augmentation, while perichondrium-attached cartilage graft is better for structural support in nasal reconstruction. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints. Methods We evaluated 163 joints in 124 patients, divided into 138 SR implants in 102 patients and 25 perichondrium transplantations in 22 patients. Our primary outcome was any revision surgery of the index joint. Results The median follow-up time was 6 years (0–21) for the SR implants and 26 years (1–37) for the perichondrium transplants. Median age at index surgery was 64 years (24–82) for SR implants and 45 years (18–61) for perichondium transplants. MCP joint survival was slightly better in the perichondrium group (86.7%; 95% confidence interval [CI]: 69.4–100.0) than in the SR implant group (75%; CI 53.8–96.1), but not statistically significantly so (p = 0.4). PIP joint survival was also slightly better in the perichondrium group (80%; CI 55–100) than in the SR implant group (74.7%; CI 66.6–82.7), but below the threshold of statistical significance (p = 0.8). Conclusion In conclusion, resurfacing of finger joints using transplanted perichondrium is a technique worth considering since the method has low revision rates in the medium term and compares favorable to SR implants. Level of evidence III (Therapeutic).

Abstract Background Gratifying long-term results are difficult to achieve when reconstructing osteoarthritic finger joints. Implant surgery is the most commonly used method to restore function and dexterity. However, all types of implant have disadvantages and may be a less favorable option in some cases, especially in young patients with a long expected lifetime and high demands on manual load. Implant related complications as loosening, instability, subsidence and stiffness are the main concerns. In this context, joint reconstruction using rib perichondrium might be a reasonable alternative in selected cases. The aim of the study was to evaluate the long-term results of finger joint reconstruction using rib perichondrial transplantation. Methods The study group (n = 11) consisted of eight individuals reconstructed in the proximal interphalangeal (PIP) joints and three reconstructed in the metacarpophalangeal (MCP) joints during 1974–1981. All patients were evaluated at clinical visits (median: 37 years after perichondrial transplantation, range: 34–41 years) using radiographs, disability in arm-shoulder-hand (DASH) score, Visual Analog Scale (VAS), range-of-motion (ROM) and manual strength (JAMAR). Results None of the 11 patients had undergone additional surgery. All of the PIP-joints (n = 8) were almost pain-free at activity (VAS 0,6) (range 0–4), had an average range-of-motion of 41 degrees (range 5–80) and a mean DASH-score of 8,3 (range 1–51). The mean strength was 41 kg compared to 44 kg in the contralateral hand (93%). The three MCP joints were almost pain-free at activity (VAS 0,7), (range 0–1). The ROM was on average 80 degrees (range 70–90) and the mean DASH-score was 2 (range 1–3). The mean strength was 43 kg compared to 53 kg in the contralateral hand (81%). Conclusions Perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure. Additional studies are needed to evaluate long-term results in comparison to modern implants and to better describe the factors that determine the outcome of these procedures. Level of evidence Level IV, Therapeutic Study.

To investigate the role of IGF-I signaling in osterix (OSX)-expressing cells in the skeleton, we generated IGF-I receptor (IGF-IR) knockout mice ((OSX)IGF-IRKO) (floxed-IGF-IR mice × OSX promoter-driven GFP-labeled cre-recombinase [(OSX)GFPcre]), and monitored postnatal bone development. At day 2 after birth (P2), (OSX)GFP-cre was highly expressed in the osteoblasts in the bone surface of the metaphysis and in the prehypertrophic chondrocytes (PHCs) and inner layer of perichondral cells (IPCs). From P7, (OSX)GFP-cre was highly expressed in PHCs, IPCs, cartilage canals (CCs), and osteoblasts (OBs) in the epiphyseal secondary ossification center (SOC), but was only slightly expressed in the OBs in the metaphysis. Compared with the control mice, the IPC proliferation was decreased in the (OSX)IGF-IRKOs. In these mice, fewer IPCs invaded into the cartilage, resulting in delayed formation of the CC and SOC. Immunohistochemistry indicated a reduction of vessel number and lower expression of VEGF and ephrin B2 in the IPCs and SOC of (OSX)IGF-IRKOs. Quantitative real-time PCR revealed that the mRNA levels of the matrix degradation markers, MMP-9, 13 and 14, were decreased in the (OSX)IGF-IRKOs compared with the controls. The (OSX)IGF-IRKO also showed irregular morphology of the growth plate and less trabecular bone in the tibia and femur from P7 to 7 weeks, accompanied by decreased chondrocyte proliferation, altered chondrocyte differentiation, and decreased osteoblast differentiation. Our data indicate that during postnatal bone development, IGF-I signaling in OSX-expressing IPCs promotes IPC proliferation and cartilage matrix degradation and increases ephrin B2 production to stimulate vascular endothelial growth factor (VEGF) expression and vascularization. These processes are required for normal CC formation in the establishment of the SOC. Moreover, IGF-I signaling in the OSX-expressing PHC is required for growth plate maturation and osteoblast differentiation in the development of the metaphysis.

Introduction: The use of the endoscope in otological surgeries has both diagnostic and therapeutic values. It provides an excellent view in difficult nooks and corners. The use of endoscopic sandwich myringoplasty using cartilage and perichondrium has its benefit in hearing outcome and graft uptake in long-term follow-up. The main objective was to compare the long-term with short-term hearing outcomes in those who have undergone endoscopic sandwich myringoplasty with Dhulikhel hospital (D-HOS) technique. Materials and Methods: Forty-two patients who underwent endoscopic sandwich myringoplasty with D-HOS technique using tragal cartilage perichondrium were enrolled in the study. The hearing outcome was analyzed by comparing the preoperative findings with post-operative findings and amongst post-operative patients, long-term with short-term air bone gap (ABG) and ABG closure in speech frequencies (0.5kHz, 1kHz, 2kHz, 4kHz) were compared. Results: Amongst forty-two patients, 40 (95.2%) had graft uptake in both short-term (6.08 months) and in long-term (20 months) follow-up. The mean pre-operative ABG was 28.1±9.3dB whereas the mean short-term post-operative ABG was 14.5±7.2dB, it showed statistical significance (P=0.001). Likewise, while comparing pre-operative with long-term post-operative ABG (13.4±4.8 dB), it showed statistical significance of P=0.000. While comparing short-term with long-term post-operative ABG, it did not show any statistical significance (P=0.065).The mean closure in ABG in both short-term and long-term hearing assessment was not statistically significant (P=0.077). Conclusion: Endoscopic sandwich myringoplasty with D-HOS technique is a reliable procedure with good hearing outcome and graft uptake in both short and long-term follow-up. [ABSTRACT FROM AUTHOR]

Background: Literature regarding medial collateral ligament (MCL) injuries is focused on adults with superficial MCL disruptions. However, children follow different injury patterns, with avulsion fractures at ligament attachment sites occurring commonly. Such avulsions have not been characterized for pediatric MCL injuries. Objective: To elucidate imaging findings, and review management and outcomes of pediatric MCL avulsion fractures. Materials and methods: We conducted a 10-year retrospective review of knee magnetic resonance (MR) imaging reports for patients younger than 16 years old diagnosed with acute MCL avulsion fracture. MR imaging was reviewed to confirm and characterize the components of the avulsion (perichondrium without or with cartilage, and/or bone) and to identify additional knee injuries. Radiographs, if available, from the time of injury were reviewed. Clinical management and patient outcomes were recorded. Results: Eighteen patients (13 boys, 5 girls) incurred an acute MCL avulsion fracture. All avulsions involved the deep MCL attachment: 17 meniscofemoral and 1 meniscotibial component. Two avulsions also included the superficial MCL attachment. Nine boys had non-osseous avulsions, all radiographically occult. All girls had radiographically apparent avulsions. Three girls and three boys sustained associated knee derangements, most commonly anterior cruciate ligament (ACL) injury (n=4). All MCL avulsions were initially treated conservatively; one child required subsequent surgery for ongoing pain. Conclusion: Pediatric MCL avulsion fractures in this study uniformly involve the attachment of the deep MCL and can be entirely non-osseous, particularly in boys who lag in skeletal maturity, making these injuries radiographically occult. MR imaging may be required to recognize these avulsions, which can impact the duration of rest and knee bracing. [ABSTRACT FROM AUTHOR]

Abstract Background There are no studies in the literature, comparing the functional and anatomical successes of the use of fascial and perichondrial grafts in endoscopic type 1 tympanoplasties. Objectives To compare the anatomical and functional outcomes of grafting with the fascia of the temporalis muscle and with the perichondrium of the tragal cartilage in patients undergoing primary transcanal type 1 tympanoplasty with endoscopy. Methods We enrolled a total of 151 patients (80 females and 71 males with a mean age of 26.0 ± 9.3 years in the age range between 18-57) with MERI scores ranging from 1 to 3 and who underwent a transcanal endoscopic type 1 tympanoplasty without tympanomeatal flap elevation. The patients were assigned to two groups according to the type of the graft used. The patients were assigned to either the tragal cartilage perichondrium group (Group A) or the fascia of the temporal muscle (Group B). The groups were compared according to the pre- and postoperative air-bone gaps and to the status of the tympanic membrane. Results There were no statistically significant differences in the distribution of the age, gender, localization, MERI scores, the duration of the operation, and the size of the perforation (all p values> 0.05). The pre-operative air-bone gap values of Group A and B did not show a statistically significant difference (p = 0.073). The postoperative improvement in the air-bone gap value did not demonstrate a significant difference between Group A and B (p = 0.202). The graft retention rates were 94.9 and 97.2% in Group A and in Group B respectively. There were no statistically significant differences between the two groups in terms of the graft retention success rates (p = 0.743). Conclusion Perichondrium and fascia were suitable for use in endoscopic tympanoplasties.

Introduction Temporalis fascia is the commonly used graft material for tympanic membrane reconstruction. Tragal perichondrium share with the fascia the quality of being mesenchymal tissue. In our study we compared perichondrium and temporalis fascia in terms of graft uptake and hearing improvement. Materials and Methods All patients presenting with discharge from ear and decreased hearing were subjected to clinical examination and investigation. Patients satisfying inclusion criteria were included in study with total of 40 patients. Twenty underwent type1 tympanoplasty with temporalis fascia (TF) and another 20 patients with tragal perichondrium (TP). To evaluate success patients are evaluated at end of 6 months for graft uptake and 3 months for hearing results in audiological gain of 10 dB in two consecutive frequencies. Results Mean Pre-op AC Threshold in TF group was 30.75 dB±5.16 and Post-op AC Threshold was 14.15 dB±8.05. Mean Pre-op AC Threshold in TP group was 32.2 dB±4.81 and Post-op AC Threshold was 20.95 dB±7.14. Mean post-op AC Threshold, Mean Post-Op AB Gap and Mean Audiological Gain was statistically significant among 2 groups p=0.0075, p=0.0013, p=0.0294 respectively. Temporalis fascia was better than Tragal Perichondrium. Graft uptake in 2 groups was not significant (p=0.6325). Conclusion From the present study we may conclude that temporalis fascia, tragal perichondrium free grafts provide viable autograft material for tympanoplasty. Both achieve good hearing restoration but the improvement in hearing or audiological gain is better in temporalis fascia graft than in tragal perichondrium graft.

The diversity of skeletal tissues in extant vertebrates includes mineralized and unmineralized structures made of bone, cartilage, or tissues of intermediate nature. This variability, together with the diverse nature of skeletal tissues in fossil species question the origin of skeletonization in early vertebrates. In particular, the study of skeletal tissues in cartilaginous fishes is currently mostly restrained to tessellated cartilage, a derived form of mineralized cartilage that evolved at the origin of this group. In this work, we describe the architectural and histological diversity of neural arch mineralization in cartilaginous fishes. The observed variations in the architecture include tessellated cartilage, with or without more massive sites of mineralization, and continuously mineralized neural arches devoid of tesserae. The histology of these various architectures always includes globular mineralization that takes place in the cartilaginous matrix. In many instances, the mineralized structures also include a fibrous component that seems to emerge from the perichondrium and they may display intermediate features, ranging from partly cartilaginous to mostly fibrous matrix, similar to fibrocartilage. Among these perichondrial mineralized tissues is also found, in few species, a lamellar arrangement of the mineralized extracellular matrix. The evolution of the mineralized tissues in cartilaginous fishes is discussed in light of current knowledge of their phylogenetic relationships.

The definition of quality controls for cell therapy and engineered product manufacturing processes is critical for safe, effective, and standardized clinical implementation. Using the example context of cartilage grafts engineered from autologous nasal chondrocytes, currently used for articular cartilage repair in a phase II clinical trial, we outlined how gene expression patterns and generalized linear models can be introduced to define molecular signatures of identity, purity, and potency. We first verified that cells from the biopsied nasal cartilage can be contaminated by cells from a neighboring tissue, namely perichondrial cells, and discovered that they cannot deposit cartilaginous matrix. Differential analysis of gene expression enabled the definition of identity markers for the two cell populations, which were predictive of purity in mixed cultures. Specific patterns of expression of the same genes were significantly correlated with cell potency, defined as the capacity to generate tissues with histological and biochemical features of hyaline cartilage. The outlined approach can now be considered for implementation in a good manufacturing practice setting, and offers a paradigm for other regenerative cellular therapies.

Objective: To compare the graft success rates and hearing results of single-layered (composite island) grafting (SLG) vs double-layered (composite plus second layer of perichondrium) grafting (DLG) for over-under type 1 tympanoplasty techniques.Study Design: Retrospective chart review.Settings: Tertiary center otorhinolaryngology clinic.Subjects and Methods: Medical charts of the patients who underwent type 1 tympanoplasty via the microscopic technique by a single surgeon between 2015 and 2019 were analyzed.Results: A total of 48 patients were included. The DLG (n = 26) group had higher graft take rates as compared to the SLG group (n = 22) for all patients (P = .038) and for moderate- to high-risk patients according to Middle Ear Risk Index (MERI) scores (P = .029) but not for patients with mild disease (P = .429) or myringosclerotic patients (P = .242). The DLG group exhibited higher air-bone gap closure (C-ABG) values as compared to the SLG group for all patients (P = .018). However, there was no noticeable difference in C-ABG values within the patients with successful grafting (P = .217). Only graft success status had a significant effect on C-ABG values when the multivariate linear regression was performed. (P = .016). Higher MERI scores and presence of myringosclerosis were related to the unsuccessful grafting (P < .01).Conclusion: DLG tympanoplasty is encouraged, especially for patients with higher MERI scores, to increase the graft success rates. Better hearing outcomes of DLG tympanoplasty were related to the higher graft success status of this technique; DLG had no additional hearing effect for patients with successful grafting. Higher MERI scores and presence of myringosclerosis were related to graft failure. [ABSTRACT FROM AUTHOR]

Background: Gratifying long-term results are difficult to achieve when reconstructing osteoarthritic finger joints. Implant surgery is the most commonly used method to restore function and dexterity. However, all types of implant have disadvantages and may be a less favorable option in some cases, especially in young patients with a long expected lifetime and high demands on manual load. Implant related complications as loosening, instability, subsidence and stiffness are the main concerns. In this context, joint reconstruction using rib perichondrium might be a reasonable alternative in selected cases. The aim of the study was to evaluate the long-term results of finger joint reconstruction using rib perichondrial transplantation.Methods: The study group (n = 11) consisted of eight individuals reconstructed in the proximal interphalangeal (PIP) joints and three reconstructed in the metacarpophalangeal (MCP) joints during 1974-1981. All patients were evaluated at clinical visits (median: 37 years after perichondrial transplantation, range: 34-41 years) using radiographs, disability in arm-shoulder-hand (DASH) score, Visual Analog Scale (VAS), range-of-motion (ROM) and manual strength (JAMAR).Results: None of the 11 patients had undergone additional surgery. All of the PIP-joints (n = 8) were almost pain-free at activity (VAS 0,6) (range 0-4), had an average range-of-motion of 41 degrees (range 5-80) and a mean DASH-score of 8,3 (range 1-51). The mean strength was 41 kg compared to 44 kg in the contralateral hand (93%). The three MCP joints were almost pain-free at activity (VAS 0,7), (range 0-1). The ROM was on average 80 degrees (range 70-90) and the mean DASH-score was 2 (range 1-3). The mean strength was 43 kg compared to 53 kg in the contralateral hand (81%).Conclusions: Perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure. Additional studies are needed to evaluate long-term results in comparison to modern implants and to better describe the factors that determine the outcome of these procedures.Level Of Evidence: Level IV, Therapeutic Study. [ABSTRACT FROM AUTHOR]

Background: Diced cartilage is a significant alternative approach to cartilage grafting. However, the viability and biomechanical properties of diced cartilage grafts remain to be improved, and the role of perichondrium is largely neglected. This study aimed to evaluate the histological and biomechanical effects of perichondrium on custom-shaped diced cartilage grafts constructed via a high-density porous polyethylene mold. Methods: Seven New Zealand rabbits were used. Unilateral auricular cartilage was harvested and divided into 2 parts, with or without perichondrium, diced into 1 × 1 × 0.5 mm cubical pieces, and filled into high-density porous polyethylene molds. Three grafts with the perichondrium removed and 3 with the perichondrium preserved were implanted subcutaneously at the dorsum. The grafts underwent biomechanical and histological tests 4, 8, and 12 weeks after the implantation. Results: The diced cartilage merged into integrated blocks without observable resorption in both groups at each time point. Additionally, the retention rate of weight was higher in the perichondrium-preserved group (P < 0.05). We observed regenerated cartilage that stained positively for type II collagen and glial fibrillary acidic protein (GFAP). A greater area of regenerated cartilage and higher scores of GFAP staining were observed in the perichondrium-preserved group (P < 0.05). The yield stress and modulus of elasticity were also higher in the perichondrium-preserved grafts from week 8 after implantation (P < 0.05). Conclusions: Diced cartilage grafts with a custom shape can be constructed using a high-density porous polyethylene mold. The preservation of perichondrium can improve graft viability and biomechanical properties. Level of evidence: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266. [ABSTRACT FROM AUTHOR]

The perichondrium is a complex structure centered at the chondro-osseous junction of growing bones. It plays an important role in both normal skeletal development and in pathological conditions. This review illustrates the normal anatomy, function and imaging appearance of the perichondrium from fetal development to older childhood. The radiologic appearance of the perichondrium in skeletal trauma, infection and tumors in which it plays a role also are reviewed. [ABSTRACT FROM AUTHOR]

Introduction Bilateral same day type I tympanoplasty scores over unilateral type I tympanoplasty in terms of convenience and conservation of resources but, it is rarely performed because of theoretical risk of postoperative sensorineural deafness. Materials and Methods A total of 60 patients with central perforation of tympanic membrane of both ears were included in this study. Thirty patients had undergone unilateral type I tympanoplasty and an equal number of patients were treated with bilateral type I tympanoplasty in the same sitting. The results were compared to evaluate the advantages and efficacy of single sitting bilateral type I tympanoplasty with unilateral type I tympanoplasty. Result Perforation closure was successful in 94.6% and 93.3% ears while hearing improvement in 82.1% and 86.6% in group I (bilateral tympanoplasty) and group II (unilateral tympanoplasty) respectively. Mean hearing gain for successfully operated ears in group I (both left and right) and group II is 18.1 dB and 16.5 dB. None of the patients developed iatrogenic sensorineural hearing loss. Discussion Bilateral perforations of the TM is a common finding and CSOM is found to be the most common cause in more than 90% of patients. The outcome of bilateral single stage tympanoplasty is sparse in the literature. Most of the reports pertain to unilateral operations with average success rates of about 60–100 %. Conclusion Single sitting bilateral type I tympanoplasty by transcanal routes is safe day care procedure with a high success rate.

Objective: We compared the operation times, graft success rates, and hearing gains between push-through (PT) myringoplasty and external auditory canal (EAC) flap tympanoplasty in patients with chronic marginal perforations., Materials and Methods: A total of 77 patients with chronic marginal perforations were randomly allocated to endoscopic perichondrium-cartilage myringoplasty with raising of the EAC flaps (n = 39) and PT technique (n = 38) groups. The graft outcomes, mean operation times, and postoperative complications were compared 6 months after operation., Results: The graft success rate was 97.4% (38/39) in the EAC group and 81.6% (31/38) in the PT group; the difference was significant ( P = .056). The mean operation time was 40.7 ± 10.4 min in the EAC group and 42.4 ± 8.3 min in the PT group ( P = .741). In the EAC group, the mean pre- and postoperative air-bone gap (ABG)s were 29.3 (range: 28.4 ± 8.6) and 12.1 (range: 11.8 ± 2.4) dB ( P < .01), respectively; the respective values were 29.5 (range: 29.1 ± 5.4) and 12.6 (range: 12.0 ± 1.3) dB ( P < .01) in the PT group. No significant group difference was observed in the pre- ( P = .794) or postoperative ( P = .689) ABG values or mean ABG gain (16.7 ± 5.3 vs 17.1 ± 7.7 dB; P = .526). In addition, graft medialization occurred in 7.9% patients in the PT group. However, graft lateralization, significant blunting, deteriorative sensorineural hearing loss, vertigo, or tinnitus were not encountered in either group. No taste change was reported and no inclusion cholesteatoma was seen in the EAC group., Conclusion: Endoscopic perichondrium-cartilage myringoplasty with raising of an EAC flap is useful and minimally invasive to repair chronic marginal perforations; the technique is simple, has a high graft success rate in comparison to the PT technique., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Pseudocyst or seroma of the pinna is the accumulation of serous fluid between the perichondrium and cartilage of pinna. Though there are several surgical techniques in the treatment of seroma, recurrence is common. The aim and objective of this preliminary study is to present and discuss a novel technique of treating pseudocyst of pinna which is practiced at Karwar Institute of Medical sciences. A prospective study was done with a novel procedure "Transwindow suture technique" for the treatment of pseudocyst of pinna in four patients. Three of the four patients had a very good results without any recurrence. One patient had a small quantity of recollection due to premature closure of the skin window which was successfully corrected. In this preliminary study we had encouraging results in the treatment of pseudocyst of pinna. A large scale prospective study would demonstrate the effectiveness of this procedure. [ABSTRACT FROM AUTHOR]

The aim of this project was to investigate the effects of different types of graft material, and different remaining segments of the native TM on its motion. In twelve human temporal bones, controlled TM perforations were made to simulate three different conditions. (1) Central perforation leaving both annular and umbo rims of native TM. (2) Central perforation leaving only a malleal rim of native TM. (3) Central perforation leaving only an annular rim of native TM. Five different graft materials (1) perichondrium (2) silastic (3) thin cartilage (4) thick cartilage (5) Lotriderm® cream were used to reconstruct each perforation condition. Umbo and stapes vibrations to acoustic stimuli from 250 to 6349 Hz were measured using a scanning laser Doppler vibrometer. Results showed that at low frequencies: in the Two Rims condition, all grafting materials except thick cartilage and Lotriderm cream showed no significant difference in umbo velocity from the Normal TM, while only Lotriderm cream showed a significant decrease in stapes velocity; in the Malleal Rim condition, all materials showed a significant decrease in both umbo and stapes velocities; in the Annular Rim condition, all grafting materials except Lotriderm and perichondrium showed no significant difference from the Normal TM in stapes velocity. Umbo data might not be reliable in some conditions because of coverage by the graft. At middle and high frequencies: all materials showed a significant difference from the Normal TM in both umbo and stapes velocities for all perforation conditions except in the Annular Rim condition, in which silastic and perichondrium showed no significant difference from the Normal TM at umbo velocity in the middle frequencies. In the low frequencies, the choice of repair material does not seem to have a large effect on sound transfer. Our data also suggests that the annular rim could be important for low frequency sound transfer. [ABSTRACT FROM AUTHOR]

Background: Tympanoplasty is regularly performed in various ages but data about the procedure in elderly is insufficient. Objectives: To compare the success rates and hearing outcomes of fascia and perichondrium grafts used for tympanoplasty in patients >65 years and to evaluate the prognostic factors affecting the success of tympanoplasty. Methods: Reviewing records of 49 elderly patients underwent tympanoplasty, two groups were constituted: perichondrium (25 patients) and fascia (24 patients) groups. Ages, genders, perforation sides, type and location of perforation, graft success rates, functional success rates and air–bone gap (ABG) gains were compared. Results: Overall graft success rate was 85.7%. After a mean follow-up of 23.3 ± 8.32 months, overall mean ABG gain was 11.33 ± 8.42 dB. Overall median postoperative ABG value (9 dB) was significantly lower compared to the median preoperative value (24 dB) (p <.001). Graft success rate was higher in perichondrium group (96%) compared to fascia group (75%) (p =.04). Functional success rate did not significantly differ between perichondrium (68%) and fascia groups (62.5%) (p =.68). Conclusion and significance: Tympanoplasty is an effective procedure with a graft success rate of 85.7% in elderly. Both fascia and perichondrium are suitable materials; however, perichondrium had higher success rate. [ABSTRACT FROM AUTHOR]

Objectives: The anatomical and functional success rates of tragal cartilage perichondrium and temporal muscle fascia, in pediatric patients who underwent endoscopic type 1 tympanoplasty with limited tympanomeatal flap elevation, were compared. Methods: In total, 35 pediatric patients (21 females, 14 males; mean age 11.0 ± 1.5 years; range 8–14 years) who underwent transcanal endoscopic type 1 tympanoplasty with limited elevation of the tympanomeatal flap were included in this study. Patients in group A received a tragal cartilage perichondrium graft and those in group B received a temporal muscle fascia graft. The groups were compared with respect to the pre- and postoperative air–bone gap (ABG) and tympanic membrane status. Results: The mean preoperative and postoperative ABG were 27.0 ± 9.2 and 9.0 ± 8.5 dB in group A, and 26.8 ± 8.8 and 11.6 ± 9.2 dB in group B, respectively. The group differences in pre- and postoperative ABG values were not significant (p = 0.882 and p = 0.417, respectively). However, in both groups, the postoperative ABG was significantly lower than the preoperative ABG (both p = 0.0001). The graft retention rate was 100% in group A and 88.2% in group B; the difference was not statistically significant (p = 0.134). There was also no statistically significant difference between the pre- and postoperative bone conduction values of the patients at 0.5, 1, 2, 3 or 4 kHz (all p > 0.05). Conclusions: Our study demonstrated that in pediatric patients undergoing endoscopic tympanoplasty, both the tragal cartilage perichondrium and the temporal muscle fascia can be used successfully and safely as grafts in endoscopic type 1 tympanoplasty performed by limited tympanomeatal flap elevation. [ABSTRACT FROM AUTHOR]

Rhinoplasty, via either an open or a closed approach, is classically performed in the supraperichondrial plane, i.e. underneath the SMAS. Total subperichondrial and subperiosteal approaches, providing large exposure of all of the osteocartilaginous framework of the nose, have been described in recent years. This deeper dissection requires adaptation of surgical instruments to perform both subperichondrial and subperiosteal dissection, but also to perform osteotomies. New tools, such as the Rhinosculpture or piezoelectric motor are particularly useful in this context. Acquisition of this dissection technique, although it requires a long learning curve, is largely rewarded by the advantages of this technique in primary and secondary rhinoplasty. The objective of this technical note is to provide a detailed description of the operative technique and the instrumentation required. [ABSTRACT FROM AUTHOR]

Tendon and bone are attached by a transitional connective tissue that is morphologically graded from tendinous to osseous and develops from bipotent progenitors that co-express scleraxis (Scx) and Sox9 (Scx+/Sox9+). Scx+/Sox9+ progenitors have the potential to differentiate into either tenocytes or chondrocytes, yet the developmental mechanism that spatially resolves their bipotency at the tendon-bone interface during embryogenesis remains unknown. Here, we demonstrate that development of Scx+/Sox9+ progenitors within the mammalian lower jaw requires FGF signaling. We find that loss of Fgfr2 in the mouse tendon-bone interface reduces Scx expression in Scx+/Sox9+ progenitors and induces their biased differentiation into Sox9+ chondrocytes. This expansion of Sox9+ chondrocytes, which is concomitant with decreased Notch2-Dll1 signaling, prevents formation of a mixed population of chondrocytes and tenocytes, and instead results in ectopic endochondral bone at tendon-bone attachment units. Our work shows that FGF signaling directs zonal patterning at the boundary between tendon and bone by regulating cell fate decisions through a mechanism that employs Notch signaling. [ABSTRACT FROM AUTHOR]

Objectives: Current strategies for external ear reconstruction can lead to donor site morbidity and/or surgical complications. Tissue-engineered auricular tissues may provide readily available reconstructive materials that resemble native auricular tissue, which is composed of a cartilaginous region sandwiched between two perichondrial layers. We previously developed scaffold-free bi-layered auricular tissues, consisting of a perichondrial layer and a cartilaginous layer, by cultivating chondrocytes and perichondrial cells in a continuous flow bioreactor. Here, we aimed to improve construct properties and develop strategies to engineer tri-layered auricular constructs that better mimic native auricular tissue.Study Design: Experimental study.Methods: Different concentrations of insulin-like growth factor (IGF)-1 and insulin were supplemented during bioreactor culture to determine conditions for engineering bi-layered constructs. We also investigated two methods of engineering tri-layered constructs. Method 1 used Ficoll separation to isolate perichondrial cells, followed by the seeding of isolated perichondrial cells onto the opposing side of the bi-layered constructs. Method 2 involved the growth of the bi-layered constructs in osteogenic culture medium.Results: The combination of 10 nM IGF-1 and 100 nM insulin led to increased collagen content in the engineered bi-layered constructs. For developing tri-layered constructs, method 2 yielded thicker constructs with better mechanical and biochemical properties compared to method 1. In addition, the presence of the perichondrial layers protected the engineered constructs from tissue calcification.Conclusion: Auricular tissues with a biomimetic microstructure can be created by growing chondrocytes and perichondrial cells in a continuous flow bioreactor, followed by cultivation in osteogenic medium.Level Of Evidence: NA Laryngoscope, 129:E272-E283, 2019. [ABSTRACT FROM AUTHOR]

Background: The endoscope has diagnostic and therapeutic role in different otological surgeries. It has excellent view of images where there are difficult nooks and corners. The use of sandwich cartilage perichondrium in the repair of tympanic membrane peroration has its own benefit in graft uptake and hearing results whether long term or short term. The main purpose of the present study was to evaluate the long-term hearing results in patients who underwent endoscopic sandwich myringoplasty with Dhulikhel Hospital (D-HOS) technique. Materials and Methodology: This was a prospective, cohort study performed among 45 patients who underwent endoscopic sandwich myringoplasty with D-HOS technique using tragal cartilage and perichondrium. The hearing was assessed by comparing pre- with post-operative air-bone gap (ABG) and ABG closure in speech frequencies (0.5 kHz, 1 kHz, 2 kHz, and 4 kHz). Results: Among forty-five patients, 42 (93.3%) had graft uptake in 12 months of follow-up. The postoperative ABG (17.0 ± 8.5 dB) was lesser than preoperative ABG (27.3 ± 12.5 dB) with statistically significant results. Conclusion: Endoscopic sandwich myringoplasty with D-HOS technique is a safe procedure with high-graft uptake rate and good long-term hearing results. [ABSTRACT FROM AUTHOR]

To compare the functional and anatomical success rates of the fascial versus perichondrial grafts in pediatric endoscopic type 1 tympanoplasties. This retrospective clinical study was conducted on 40 pediatric patients (23 females and 17 males; mean age: 10.0 ± 1.7 years; the age range: 6–13) who were operated with a transcanal endoscopic type 1 tympanoplasty. The study participants were assigned to two groups by graft types. The patients were assigned to either the tragal cartilage perichondrium group (Group A) or the fascia of the temporal muscle (Group B). The groups were compared according to the pre- and postoperative air-bone gaps and to the status of the tympanic membrane. There were not any statistically significant differences between the groups in terms of the distribution of age, gender, the operation sites, the duration of the operation, MERI scores or the size of the perforation (all p values > 0.05). The graft retention success rates were 94.7% and 90.5% in Group A and Group B, respectively. There were no statistically significant differences between the two groups in terms of the graft retention success rates (p = 0.609). The functional (audiological) success rate was statistically higher in Group B compared to Group A (p = 0.044). Perichondrium and fascia grafts were found out to be acceptable for use in pediatric endoscopic tympanoplasties. The functional success rates were higher in the fascia group. We also recommended the fascia as a graft in pediatric transcanal endoscopic type 1 tympanoplasties. [ABSTRACT FROM AUTHOR]

Background: Through precise implementation of distinct cell type specification programs, differentially regulated in both space and time, complex patterns emerge during organogenesis. Thanks to its easy experimental accessibility, the developing chicken limb has long served as a paradigm to study vertebrate pattern formation. Through decades' worth of research, we now have a firm grasp on the molecular mechanisms driving limb formation at the tissue-level. However, to elucidate the dynamic interplay between transcriptional cell type specification programs and pattern formation at its relevant cellular scale, we lack appropriately resolved molecular data at the genome-wide level. Here, making use of droplet-based single-cell RNA-sequencing, we catalogue the developmental emergence of distinct tissue types and their transcriptome dynamics in the distal chicken limb, the so-called autopod, at cellular resolution. Results: Using single-cell RNA-sequencing technology, we sequenced a total of 17,628 cells coming from three key developmental stages of chicken autopod patterning. Overall, we identified 23 cell populations with distinct transcriptional profiles. Amongst them were small, albeit essential populations like the apical ectodermal ridge, demonstrating the ability to detect even rare cell types. Moreover, we uncovered the existence of molecularly distinct sub-populations within previously defined compartments of the developing limb, some of which have important signaling functions during autopod pattern formation. Finally, we inferred gene co-expression modules that coincide with distinct tissue types across developmental time, and used them to track patterning-relevant cell populations of the forming digits. Conclusions: We provide a comprehensive functional genomics resource to study the molecular effectors of chicken limb patterning at cellular resolution. Our single-cell transcriptomic atlas captures all major cell populations of the developing autopod, and highlights the transcriptional complexity in many of its components. Finally, integrating our data-set with other single-cell transcriptomics resources will enable researchers to assess molecular similarities in orthologous cell types across the major tetrapod clades, and provide an extensive candidate gene list to functionally test cell-type-specific drivers of limb morphological diversification. [ABSTRACT FROM AUTHOR]

Aims and Objective: The present study was undertaken to compare the results of various autogenous tissues temporalis fascia, tragal perichondrium, and vein as graft materials for the Type 1 tympanoplasty. Materials and Methods: A total of 120 cases with large, subtotal, and total perforation were considered in the study. Of the 120 cases, temporalis fascia graft was used in 60 cases (Group-I), tragal perichondrium graft in 40 cases (Group-II), and vein graft in 20 cases (Group-III). The results were evaluated in the form of rate of graft success, hearing gain, and mean residual air-bone gap with respect to the graft materials. Results and Observation: A nonsignificant association was observed between the groups, that is, temporalis fascia (Group-I), tragal perichondrium (Group-II), and venous graft (Group-III), and the graft uptake (P = 0.96 > 0.05) and air-bone closure (χ2 = 2.908, P = 0.059 > 0.05). Conclusion: The graft take up rate and hearing improvement are similar for the different graft materials used. Size of the perforation does not significantly influence the success rate of tympanoplasty as per our study. Normal translucent appearance of neotympanum in the postoperative period was seen only with temporalis fascia and venous graft, while in tragal perichondrial, the neotympanum was whitish, thicker, and translucent to opaque. [ABSTRACT FROM AUTHOR]

Summary Background The excision of melanoma of the external ear poses a challenge to surgeons, who must achieve adequate oncological control while minimising impact on form and function. Cartilage-preserving surgery is an attractive option, as it leaves behind a scaffold for immediate reconstruction with a variety of techniques including full-thickness skin grafts (FTSGs) and local flaps. This manuscript will review the literature comparing cartilage-sparing surgery with composite excision of the skin and the cartilage for the treatment of auricular melanoma. We report the results of a 17 year experience of using both techniques, together with sentinel node biopsy at our centre. Methods A structured review of MEDLINE and EMBASE was conducted to evaluate all studies reporting local recurrence or survival rates for melanoma of the external ear treated with cartilage-preserving surgery. A retrospective review of all patients undergoing wide local excision (WLE) and sentinel lymph node biopsy (SLNB) for auricular melanoma at our centre between 2000 and 2017 was performed. Results Of 40 patients identified, 29 underwent cartilage-preserving surgery with no local recurrences or evidence of perichondral involvement. There was one local recurrence out of 11 patients who had their cartilage excised. There were no significant differences in recurrence rates or melanoma-specific survival rates when comparing cartilage-preserving and cartilage-sparing surgery. Our results are supported by the literature review, which suggests that cartilage-sparing surgery is gaining acceptance as a safe practice. [ABSTRACT FROM AUTHOR]

Background: Limited information is available on the biological status of transplanted cartilage from which the perichondrium has been removed. This article describes the histological and three-dimensional structural picture of cartilage, using green fluorescent protein (GFP) transgenic rats and normal wild rats. Methods: Three sections of costal cartilage were harvested from 10-week-old wild rats. One section was used as a specimen while two were subcutaneously collected from the dorsal region of 10-week-old GFP rats at 4 and 8 weeks post-transplant. The experiment was performed in two randomized groups. The perichondrium was removed from transplanted cartilage in the first group and perichondrium of transplanted cartilage remained intact in the second group. Histology and focused ion beam/scanning electron microscope (FIB/SEM) tomography were used to evaluate the transplanted cartilage. Results: All 40 transplanted sections were harvested and no infections, exposure or qualitative change of cartilage matrix were seen following transplant. Histological analyses showed that the surface layer of the GFP-negative transplanted cartilage was replaced with GFP-positive chondrocytes 8 weeks post-transplant in the first group. A three-dimensional layer of perichondrium-like tissue reconstructed around the cartilage at 8 weeks was confirmed, resembling normal perichondrium. However, the GFP-positive chondrocytes were not replaced in the second group. Conclusions: The cell renewal of chondrocytes is necessary for subcutaneously transplanted cartilage to maintain its tissue composition over a long period of time. The histological and ultrastructural analyses revealed that cells from recipient tissue generated new chondrocytes even when cartilage was implanted after removing the perichondrium. [ABSTRACT FROM AUTHOR]

During early bone formation, mesenchymal cells condense and then differentiate into collagen type II‐expressing chondrocytes that make up the cartilaginous bone anlagen. This anlage then becomes enclosed by the perichondrium. The mechanisms by which the perichondrium forms are not known. The purpose of this study was to determine whether epiphyseal chondrocytes can differentiate into perichondrial cells. Novel perichondrium markers were identified by expression microarray of microdissected rat perichondrium and growth plate cartilage. A dissection method that allowed for removal of contaminating perichondrium was developed and the absence was confirmed by histological examination and by expression of perichondrium markers. Perichondrium formation surrounding chondrocyte pellets was studied using histology, real‐time PCR, and in situ hybridization for chondrocyte and perichondrium markers. Cultured chondrocyte pellets developed an exterior perichondrium‐like layer. This surrounding tissue did not express chondrocyte markers, collagen‐type II and type X, as assessed by in situ hybridization. Instead, perichondrium markers, periostin, Dickkopf 3 (Dkk3), roundabout 2, cadherin 2, L‐galectin 1 (Lgals1), and thrombospondin 2 (Thbs2) were upregulated following formation of the perichondrium‐like layer as assessed by real‐time PCR. Interestingly, markers specific for the cambium layer, Dkk3, Thbs2, and Lgals1, but not for the fibrous layer, collagen‐type XIV and decorin, were upregulated. The findings suggest that epiphyseal chondrocytes of postnatal animals retain the potential to differentiate into perichondrial cells, supporting the hypothesis that the perichondrium originates from collagen type II‐expressing chondrocytes at the periphery of the cartilaginous bone template. © 2018 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the results of closure of big central and subtotal perforation by Tympanoplasty using underlay technique with Composite graft of tragal perichondrium supported by a ring of cartilage peripherally. Our hypothesis was that the cartilage support offers an extremely reliable method for reconstruction of the tympanic membrane in cases of advanced middle ear pathology and Eustachian tube dysfunction and also revision cases. Prospective study of patients undergoing tympanoplasty in big central and subtotal perforation with graft supported by a ring of cartilage peripherally between June 2016 and August 2016. Hearing results were reported using four frequency (500, 1000, 2000 and 3000) pure tone average air-bone gap. During the study period, composite graft comprising of tragal perichondrium and peripheral ring of cartilage prepared from ipsilateral tragus was used for tympanic membrane reconstruction in 30 patients. Overall graft take rate was 93.33%. Complications included residual perforation in 6.67%. Cartilage ring support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation (big central perforation, subtotal perforation, anterior perforation of tympanic membrane, revision cases). [ABSTRACT FROM AUTHOR]

Introduction: Tympanoplasty is one of routinely performed surgeries in ENT practice. Using cartilage-perichondrium composite graft in selective cases gives better outcome. Aim: To study the outcome and feasibility of cartilageperichondrium composite graft in repair of complex tympanic membrane perforations. Materials and Methods: This cross-sectional, intervention study was conducted at SSIMS and RC, Tertiary Care Teaching Hospital, Davangere, Karnataka, Southern India. Study sample consisted of 30 patients with chronic otitis media- tubo tympanic type in inactive stage. Patients were randomly selected and evaluated between January 2015 to June 2016. A detailed history, clinical examination, diagnostic nasal endoscopy, otoendoscopy were done for all patients preoperatively and postoperatively at three weeks, three months and six months. Audiological evaluation was done at six months postsurgery. Cartilage-perichondrium composite graft from tragal and conchal cartilage was used for the repair of tympanic membrane in all the cases. The data were presented in proportions, percentages. Results: Of 30 cases who underwent surgery, 24 patients (80%) had large central and subtotal perforations. Only one patient had a total perforation. The remnant tympanic membrane showed atrophic changes in 16 cases (53%) and sclerotic plaque was seen in 14 cases (46%). In our study, tragal cartilage was used in 17 and conchal cartilage in 13 cases. All the patients underwent type-1 tympanoplasty. Successful graft uptake was seen in 28 cases (93%) by six months. Two patients (7%) had a residual perforation at three months and in four cases (13%), the neotympanum showed anterior blunting by the end of six months. With respect to hearing, maximum air bone gap closure achieved in our study was 21db in one patient and minimum was 3db. Average air bone gap closure achieved was 10.1db. Conclusion: Cartilage-perichondrium composite graft can be considered a good choice in repair of tympanic membrane perforations with specific selective indications.