Comparison of early fibrovascular proliferation according to orbital implant in orbital floor fracture reconstruction

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Abstract

Backgrounds: Although reports of successful treatment results of orbital fractures are numerous, histopathologic changes associated with favorable outcomes have not yet been established. The purpose of this study was to observe fibrovascular ingrowth into implants, fibrovascularization, and inflammatory reactions in surface tissues of implants in an animal model of orbital floor fractures. Methods: Twenty-four New Zealand white rabbits were used in the study. A standardized 6-mm-diameter defect was made bilaterally in the maxillary sinuses to include bone and mucosa, and an 8 × 8-mm alloplastic implant was inserted. In the control group, a bone defect was made, but no implant was inserted. Two different implant materials 1 mm in width were used: porous high-density polyethylene (Medpor, group A) and absorbable copolymer (Macropore, group B). The implants were harvested at 1, 2, and 6 weeks after implantation. Hematoxylin-eosin stains and immunohistochemical studies of basic fibroblast growth factor (bFGF) and CD31 (platelet/endothelial cell adhesion molecule) were conducted. Results: Full-thickness fibrovascular ingrowth into the implants was observed in group A after 2 weeks, but there was no fibrovascular ingrowth into the implant in group B. The inflammatory reactions between the implant and the connective tissue were grade 2 at 1 week and grade 1 at 2 and 6 weeks in both groups. The bFGF indexes in fibrovascular tissue growing into the nonabsorbable porous polyethylene implants (group A-1) were 0.3 at 1 week, 2.3 at 2 weeks, and 3.0 at 6 weeks. The bFGF indexes at the surface tissues of the implant in the nonabsorbable porous polyethylene implants (Medpor, group A-2) and group B were 1.0 and 1.8 at 1 week, 2.5 and 2.8 at 2 weeks, and 3.0 and 3.0 at 6 weeks. Expressions of CD31 in group A-1 were 3.8 at 1 week, 6.0 at 2 weeks, and 20.3 at 6 weeks. Expressions of CD31 in group A-2 and group B were 19.8 and 23.3 at 1 week, 38.0 and 49.3 at 2 weeks, and 64.3 and 72.0 at 6 weeks. Conclusions: Because there was no fibrovascular ingrowth into the absorbable copolymer implant, such implants may be advantageous in orbital wall fractures with exposures of extraocular muscle. However, the possibility of migration and extrusion of the implant cannot be excluded because there was no fibrovascular ingrowth into the absorbable copolymer implants. Therefore, nonabsorbable porous polyethylene implants are better suited for use in orbital wall fractures when there is concern about implant migration and extrusion during the early postoperative period and large orbital wall fractures.

Original languageEnglish
Pages (from-to)1518-1523
Number of pages6
JournalJournal of Craniofacial Surgery
Volume23
Issue number5
DOIs
Publication statusPublished - 2012 Sep 1

Fingerprint

Orbital Implants
Orbital Fractures
Polyethylene
Fibroblast Growth Factor 2
Absorbable Implants
varespladib methyl
Oculomotor Muscles
Bone and Bones
Maxillary Sinus
Cell Adhesion Molecules
Hematoxylin
Eosine Yellowish-(YS)
Postoperative Period
Connective Tissue
Mucous Membrane
Coloring Agents
Blood Platelets
Endothelial Cells
Animal Models
Rabbits

Keywords

  • Absorbable copolymer implant (Macropore)
  • Basic fibrovascular growth factor (bFGF)
  • CD31 (platelet endothelial cell adhesion molecule [PECAM-1])
  • Nonabsorbable porous polyethylene implant (Medpor)
  • Orbital wall fracture

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery

Cite this

@article{eff90e7301b34980b7964c36b8cf4d74,
title = "Comparison of early fibrovascular proliferation according to orbital implant in orbital floor fracture reconstruction",
abstract = "Backgrounds: Although reports of successful treatment results of orbital fractures are numerous, histopathologic changes associated with favorable outcomes have not yet been established. The purpose of this study was to observe fibrovascular ingrowth into implants, fibrovascularization, and inflammatory reactions in surface tissues of implants in an animal model of orbital floor fractures. Methods: Twenty-four New Zealand white rabbits were used in the study. A standardized 6-mm-diameter defect was made bilaterally in the maxillary sinuses to include bone and mucosa, and an 8 × 8-mm alloplastic implant was inserted. In the control group, a bone defect was made, but no implant was inserted. Two different implant materials 1 mm in width were used: porous high-density polyethylene (Medpor, group A) and absorbable copolymer (Macropore, group B). The implants were harvested at 1, 2, and 6 weeks after implantation. Hematoxylin-eosin stains and immunohistochemical studies of basic fibroblast growth factor (bFGF) and CD31 (platelet/endothelial cell adhesion molecule) were conducted. Results: Full-thickness fibrovascular ingrowth into the implants was observed in group A after 2 weeks, but there was no fibrovascular ingrowth into the implant in group B. The inflammatory reactions between the implant and the connective tissue were grade 2 at 1 week and grade 1 at 2 and 6 weeks in both groups. The bFGF indexes in fibrovascular tissue growing into the nonabsorbable porous polyethylene implants (group A-1) were 0.3 at 1 week, 2.3 at 2 weeks, and 3.0 at 6 weeks. The bFGF indexes at the surface tissues of the implant in the nonabsorbable porous polyethylene implants (Medpor, group A-2) and group B were 1.0 and 1.8 at 1 week, 2.5 and 2.8 at 2 weeks, and 3.0 and 3.0 at 6 weeks. Expressions of CD31 in group A-1 were 3.8 at 1 week, 6.0 at 2 weeks, and 20.3 at 6 weeks. Expressions of CD31 in group A-2 and group B were 19.8 and 23.3 at 1 week, 38.0 and 49.3 at 2 weeks, and 64.3 and 72.0 at 6 weeks. Conclusions: Because there was no fibrovascular ingrowth into the absorbable copolymer implant, such implants may be advantageous in orbital wall fractures with exposures of extraocular muscle. However, the possibility of migration and extrusion of the implant cannot be excluded because there was no fibrovascular ingrowth into the absorbable copolymer implants. Therefore, nonabsorbable porous polyethylene implants are better suited for use in orbital wall fractures when there is concern about implant migration and extrusion during the early postoperative period and large orbital wall fractures.",
keywords = "Absorbable copolymer implant (Macropore), Basic fibrovascular growth factor (bFGF), CD31 (platelet endothelial cell adhesion molecule [PECAM-1]), Nonabsorbable porous polyethylene implant (Medpor), Orbital wall fracture",
author = "Hwa Lee and Baek, {Se Hyun}",
year = "2012",
month = "9",
day = "1",
doi = "10.1097/SCS.0b013e31825a61de",
language = "English",
volume = "23",
pages = "1518--1523",
journal = "Journal of Craniofacial Surgery",
issn = "1049-2275",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Comparison of early fibrovascular proliferation according to orbital implant in orbital floor fracture reconstruction

AU - Lee, Hwa

AU - Baek, Se Hyun

PY - 2012/9/1

Y1 - 2012/9/1

N2 - Backgrounds: Although reports of successful treatment results of orbital fractures are numerous, histopathologic changes associated with favorable outcomes have not yet been established. The purpose of this study was to observe fibrovascular ingrowth into implants, fibrovascularization, and inflammatory reactions in surface tissues of implants in an animal model of orbital floor fractures. Methods: Twenty-four New Zealand white rabbits were used in the study. A standardized 6-mm-diameter defect was made bilaterally in the maxillary sinuses to include bone and mucosa, and an 8 × 8-mm alloplastic implant was inserted. In the control group, a bone defect was made, but no implant was inserted. Two different implant materials 1 mm in width were used: porous high-density polyethylene (Medpor, group A) and absorbable copolymer (Macropore, group B). The implants were harvested at 1, 2, and 6 weeks after implantation. Hematoxylin-eosin stains and immunohistochemical studies of basic fibroblast growth factor (bFGF) and CD31 (platelet/endothelial cell adhesion molecule) were conducted. Results: Full-thickness fibrovascular ingrowth into the implants was observed in group A after 2 weeks, but there was no fibrovascular ingrowth into the implant in group B. The inflammatory reactions between the implant and the connective tissue were grade 2 at 1 week and grade 1 at 2 and 6 weeks in both groups. The bFGF indexes in fibrovascular tissue growing into the nonabsorbable porous polyethylene implants (group A-1) were 0.3 at 1 week, 2.3 at 2 weeks, and 3.0 at 6 weeks. The bFGF indexes at the surface tissues of the implant in the nonabsorbable porous polyethylene implants (Medpor, group A-2) and group B were 1.0 and 1.8 at 1 week, 2.5 and 2.8 at 2 weeks, and 3.0 and 3.0 at 6 weeks. Expressions of CD31 in group A-1 were 3.8 at 1 week, 6.0 at 2 weeks, and 20.3 at 6 weeks. Expressions of CD31 in group A-2 and group B were 19.8 and 23.3 at 1 week, 38.0 and 49.3 at 2 weeks, and 64.3 and 72.0 at 6 weeks. Conclusions: Because there was no fibrovascular ingrowth into the absorbable copolymer implant, such implants may be advantageous in orbital wall fractures with exposures of extraocular muscle. However, the possibility of migration and extrusion of the implant cannot be excluded because there was no fibrovascular ingrowth into the absorbable copolymer implants. Therefore, nonabsorbable porous polyethylene implants are better suited for use in orbital wall fractures when there is concern about implant migration and extrusion during the early postoperative period and large orbital wall fractures.

AB - Backgrounds: Although reports of successful treatment results of orbital fractures are numerous, histopathologic changes associated with favorable outcomes have not yet been established. The purpose of this study was to observe fibrovascular ingrowth into implants, fibrovascularization, and inflammatory reactions in surface tissues of implants in an animal model of orbital floor fractures. Methods: Twenty-four New Zealand white rabbits were used in the study. A standardized 6-mm-diameter defect was made bilaterally in the maxillary sinuses to include bone and mucosa, and an 8 × 8-mm alloplastic implant was inserted. In the control group, a bone defect was made, but no implant was inserted. Two different implant materials 1 mm in width were used: porous high-density polyethylene (Medpor, group A) and absorbable copolymer (Macropore, group B). The implants were harvested at 1, 2, and 6 weeks after implantation. Hematoxylin-eosin stains and immunohistochemical studies of basic fibroblast growth factor (bFGF) and CD31 (platelet/endothelial cell adhesion molecule) were conducted. Results: Full-thickness fibrovascular ingrowth into the implants was observed in group A after 2 weeks, but there was no fibrovascular ingrowth into the implant in group B. The inflammatory reactions between the implant and the connective tissue were grade 2 at 1 week and grade 1 at 2 and 6 weeks in both groups. The bFGF indexes in fibrovascular tissue growing into the nonabsorbable porous polyethylene implants (group A-1) were 0.3 at 1 week, 2.3 at 2 weeks, and 3.0 at 6 weeks. The bFGF indexes at the surface tissues of the implant in the nonabsorbable porous polyethylene implants (Medpor, group A-2) and group B were 1.0 and 1.8 at 1 week, 2.5 and 2.8 at 2 weeks, and 3.0 and 3.0 at 6 weeks. Expressions of CD31 in group A-1 were 3.8 at 1 week, 6.0 at 2 weeks, and 20.3 at 6 weeks. Expressions of CD31 in group A-2 and group B were 19.8 and 23.3 at 1 week, 38.0 and 49.3 at 2 weeks, and 64.3 and 72.0 at 6 weeks. Conclusions: Because there was no fibrovascular ingrowth into the absorbable copolymer implant, such implants may be advantageous in orbital wall fractures with exposures of extraocular muscle. However, the possibility of migration and extrusion of the implant cannot be excluded because there was no fibrovascular ingrowth into the absorbable copolymer implants. Therefore, nonabsorbable porous polyethylene implants are better suited for use in orbital wall fractures when there is concern about implant migration and extrusion during the early postoperative period and large orbital wall fractures.

KW - Absorbable copolymer implant (Macropore)

KW - Basic fibrovascular growth factor (bFGF)

KW - CD31 (platelet endothelial cell adhesion molecule [PECAM-1])

KW - Nonabsorbable porous polyethylene implant (Medpor)

KW - Orbital wall fracture

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DO - 10.1097/SCS.0b013e31825a61de

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SP - 1518

EP - 1523

JO - Journal of Craniofacial Surgery

JF - Journal of Craniofacial Surgery

SN - 1049-2275

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