Dynamic Viscosity of Implantable Autologous Materials Into the Vocal Fold

Objective. To compare the dynamic viscosity (DV) of superficial layer of temporalis fascia (SLTF) with that of other biological tissues traditionally used for vocal fold implants to treat vocal fold rigidity. Study Design. Experimental. Method. Measurement of DV of samples of SLTF, deep layer of temporalis fascia (DLTF), and abdominal fat of 12 cadavers. Results. DV values of the different samples were presented in the following increasing order: SLTF, DLTF, and abdominal fat. There was statistical difference between the samples. Conclusion. DV of SLTF is lower than of other tissues tested.

Facial Reanimation Utilizing Combined Orthodromic Temporalis Muscle Flap and End-to-Side Cross-Face Nerve Grafts

Individuals with facial paralysis of 6 months or more without evidence of clinical or electromyographic improvement have been successfully reanimated utilizing an orthodromic temporalis transfer in conjunction with end-to-side cross-face nerve grafts. The temporalis muscle insertion is released from the coronoid process of the mandible and sutured to a fascia lata graft that is secured distally to the commissure and paralyzed hemilip. The orthodromic transfer of the temporalis muscle overcomes the concave temporal deformity and zygomatic fullness produced by the turning down of the central third of the muscle (Gillies procedure) while yielding stronger muscle contraction and a more symmetric smile. The muscle flap is combined with cross-face sural nerve grafts utilizing end-to-side neurorrhaphies to import myelinated motor fibers to the paralyzed muscles of facial expression in the midface and perioral region. Cross-face nerve grafting provides the potential for true spontaneous facial motion. We feel that the synergy created by the combination of techniques can perhaps produce a more symmetrical and synchronized smile than either procedure in isolation.Nineteen patients underwent an orthodromic temporalis muscle flap in conjunction with cross-face (buccal-buccal with end-to-side neurorrhaphy) nerve grafts. To evaluate the symmetry of the smile, we measured the length of the two hemilips (normal and affected) using the CorelDRAW X3 software. Measurements were obtained in the pre- and postoperative period and compared for symmetry.There was significant improvement in smile symmetry in 89.5 % of patients.Orthodromic temporalis muscle transfer in conjunction with cross face nerve grafts creates a synergistic effect frequently producing an aesthetic, symmetric smile.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.spinger.com/00266.

Mechanical analysis of foot plantar fascia during normal walking condition

Foot plantar fascia is an important foot tissue in stabilizing the longitudinal arch of human foot. Direct measurement to monitor the mechanical situation of plantar fascia at human locomotion is difficult. The purpose of this study was to construct a three-dimensional finite element model of the foot to calculate the internal stress/strain value of plantar fascia during different stage of gait. The simulated stress distribution of plantar fascia was the lowest at heel-strike, which concentrated on the medial side of calcaneal tubercle. The peak stress of plantar fascia was appeared at push-off, and the value is more than 5 times of the heel-strike position. Current FE model was able to explore the plantar fascia tension trend at the main sub-phases of foot. More detailed fascia model and intrinsic muscle forces could be developed in the further study.

Effects of unilateral vocal fold paralysis treatment with fascia augmentation on airflow mechanics, tracheal sounds and voice acoustics

Data on the influence of unilateral vocal fold paralysis on breathing, especially other than information obtained by spirometry, are relatively scarce. Even less is known about the effect of its treatment by vocal fold medialization. Consequently, there was a need to study the issue by combining multiple instruments capable of assessing airflow dynamics and voice. This need was emphasized by a recently developed medialization technique, autologous fascia injection; its effects on breathing have not previously been investigated. A cohort of ten patients with unilateral vocal fold paralysis was studied before and after autologous fascia injection by using flow-volume spirometry, body plethysmography and acoustic analysis of breathing and voice. Preoperative results were compared with those of ten healthy controls. A second cohort of 11 subjects with unilateral vocal fold paralysis was studied pre- and postoperatively by using flow-volume spirometry, impulse oscillometry, acoustic analysis of voice, voice handicap index and subjective assessment of dyspnoea. Preoperative peak inspiratory flow and specific airway conductance were significantly lower and airway resistance was significantly higher in the patients than in the healthy controls (78% vs. 107%, 73% vs. 116% and 182% vs. 125% of predicted; p = 0.004, p = 0.004 and p = 0.026, respectively). Patients had a higher root mean square of spectral power of tracheal sounds than controls, and three of them had wheezes as opposed to no wheezing in healthy subjects. Autologous fascia injection significantly improved acoustic parameters of the voice in both cohorts and voice handicap index in the latter cohort, indicating that this procedure successfully improved voice in unilateral vocal fold paralysis. Peak inspiratory flow decreased significantly as a consequence of this procedure (from 4.54 ± 1.68 l to 4.21 ± 1.26 l, p = 0.03, in pooled data of both cohorts), but no change occurred in the other variables of flow-volume spirometry, body-plethysmography and impulse oscillometry. Eight of the ten patients studied by acoustic analysis of breathing had wheezes after vocal fold medialization compared with only three patients before the procedure, and the numbers of wheezes per recorded inspirium and expirium increased significantly (from 0.02 to 0.42 and from 0.03 to 0.36; p = 0.028 and p = 0.043, respectively). In conclusion, unilateral vocal fold paralysis was observed to disturb forced breathing and also to cause some signs of disturbed tidal breathing. Findings of flow volume spirometry were consistent with variable extra-thoracic obstruction. Vocal fold medialization by autologous fascia injection improved the quality of the voice in patients with unilateral vocal fold paralysis, but also decreased peak inspiratory flow and induced wheezing during tidal breathing. However, these airflow changes did not appear to cause significant symptoms in patients.

Injection laryngoplasty with autologous fascia for treatment of unilateral vocal fold paralysis

The purpose of this dissertation was to study the applicability of minced autologous fascia graft for injection laryngoplasty of unilateral vocal fold paralysis (UVFP). Permanence of augmentation and host versus graft tissue reactions were of special interest. The topic deals with phonosurgery, which is a subdivision of the Ear, Nose and Throat-speciality of medicine. UVFP results from an injury to the recurrent or the vagal nerve. The main symptom is a hoarse and weak voice. Surgery is warranted for patients in whom spontaneous reinnervation and a course of voice therapy fails to improve the voice. Injection laryngoplasty is a widespread surgical technique which aims to restore glottic closure by augmenting the atrophied vocal muscle, and also by turning the paralyzed vocal fold towards midline. Currently, there exists a great diversity of synthetic, xenologous, homologous, and autologous substances available for injection. An autologous graft is perfect in terms of biocompatibility. Free fascia grafts have been successfully used in the head and neck surgery for decades, but fascia had not been previously applied into the vocal fold. The fascia is harvested from the lateral thigh under local anesthesia and minced into paste by scissors. Injection of the vocal fold is performed in laryngomicroscopy under general anesthesia. Three series of clinical trials of injection laryngoplasty with autologous fascia (ILAF) for patients with UVFP were conducted at the Department of Otorhinolaryngology of the Helsinki University Central Hospital. The follow-up ranged from a few months to ten years. The aim was to document the vocal results and possible morbidity related to graft harvesting and vocal fold injection. To address the tissue reactions and the degree of reabsoprtion of the graft, an animal study with a follow-up ranging from 3 days to 12 months was performed at the National Laboratory Animal Center, University of Kuopio. Harvesting of the graft and injection was met with minor morbidity. Histological analysis of the vocal fold tissue showed that fascia was well tolerated. Although some resorption or compaction of the graft during the first months is evident, graft volume is maintained well. When injected deep and laterally into the vocalis muscle, the fascia graft allows normal vibration of the vocal fold mucosa to occur during phonation. Improvement of voice quality was seen in all series by multiple objective parameters of voice evaluation. However, the vocal results were poor in cases where the nerve trauma was severe, such as UVFP after chest surgery. ILAF is most suitable for correction of mild to moderate glottic gaps related to less severe nerve damage. Our results indicate that autologous fascia is a feasible and safe new injection material with good and stable vocal results. It offers a practical solution for surgeons who treat this complex issue.

Cadaveric fascia lata pubovaginal slings:early results on safety, efficacy and patient satisfaction

Objective To prospectively evaluate and quantify the efficacy of cadaveric fascia lata (CFL) as an allograft material in pubovaginal sling placement to treat stress urinary incontinence (SUI).

Patients and methods Thirty-one women with SUI (25 type II and six type III; mean age 63 years, range 40-75) had a CFL pubovaginal sling placed transvaginally. The operative time, blood loss, surgical complications and mean hospital stay were all documented. Before and at 4 months and 1 year after surgery each patient completed a 3-day voiding diary and validated voiding questionnaires (functional inquiry into voiding habits, Urogenital Distress Inventory and Incontinence Impact Questionnaire, including visual analogue scales).

Results The mean (range) operative time was 71 (50-120) min, blood loss 78.7 (20-250) mL and hospital stay 1.2 (1-2) days; there were no surgical complications. Over the mean follow-up of 13.5 months, complete resolution of SUI was reported by 29 (93%) patients. Overactive bladder symptoms were present in 23 (74%) patients before surgery, 21 (68%) at 4 months and two (6%) at 1 year; 80% of patients with low (<15 cmH (2) O) voiding pressures before surgery required self-catheterization afterward, as did 36% at 4 months, but only one (3%) at 1 year. Twenty-four (77%) patients needed to adopt specific postures to facilitate voiding. After surgery there was a significant reduction in daytime frequency, leakage episodes and pad use (P <0.05). The severity of leak and storage symptoms was also significantly less (P <0.002), whilst the severity of obstructive symptoms remained unchanged. Mean subjective levels of improvement were 69% at 4 months and 85% at 1 year, with corresponding objective satisfaction levels of 61% and 69%, respectively. At 1 year, approximate to 80% of the patients said they would undergo the procedure again and/or recommend it to a friend.

Conclusion Placing a pubovaginal sling of CFL allograft is a highly effective, safe surgical approach for resolving SUI, with a short operative time and rapid recovery. Storage symptoms are significantly improved, and subjective improvement and satisfaction rates are high.

Ruptura do ligamento cruzado em cães: estudo retrospectivo da reconstituição com fascia lata

Trata-se de um estudo retrospectivo de 35 casos de ruptura de ligamento cruzado atendidos pelo Serviço de Cirurgia de Pequenos Animais da FMVZ-UNESP-Campus de Botucatu, no período janeiro de 1991 a junho de 1997. Os cães foram submetidos à técnica de PAATSAMA (1952), modificada para reconstituição do ligamento cruzado, que consistiu na passagem do retalho de fascia lata através da articulação do joelho e fixação no côndilo medial da tíbia e epicôndilo medial do fêmur. Pelos resultados obtidos, concluiu-se que esta técnica permite boa estabilização das superfícies articulares, com trans e pós operatório sem complicações, e permite recuperação completa da capacidade funcional do membro afetado.

Electromyographic evaluation of masseter and anterior temporalis muscles in resting position and during maximum tooth clenching of edentulous patients before and after new complete dentures.

The aim of this study was to assess the electrical activity of the masseter and anterior temporal muscles in patients with severe bone resorption, with complete dentures worn for over ten years, and five months after having new dentures put in place. The RDC questionnaire was applied to twelve asymptomatic patients, before and five months after new dentures were put in place. The electrical activity recordings were made in the mandibular position at rest, and during maximum tooth clenching. The electrical activity of the masseter and anterior temporal muscles in the position at rest presented no statistically significant difference after five months of wearing the new complete dentures. Electrical activity during tooth clenching exhibited a statistically significant reduction only in the right temporal muscle. A period longer than five months of wearing the new complete dentures is required for adaptation and the acquisition of functional capacity.

Electromyographic analysis of masseter and anterior temporalis muscle in sleep bruxers after occlusal splint wearing

Bruxism is widely defined as an anxiety response to environmental stress. Occlusal splints are frequently used in sleep bruxism, to protect teeth from damage resulting from the contraction force of mandibular muscles, or to reduce the orofacial pain by relaxing masticatory muscles. Surface electromyography (EMG) of the right and left masseter and temporalis muscles was performed in 15 women presenting sleep bruxism and temporomandibular disorders related to occupational stress, after nocturnal use of the occlusal splint. The EMG signals were recorded twice per patient: After a work shift (pre-splint) and after a night of sleep with the occlusal splint (post-splint) before a new workday. The parametric t-paired test was used to compare differences of the RMS amplitude between pre and post-splint records, for resting and maximal clenching effort. The level of significance for each comparison was set to p < 0.05. The results of the study supports the premise that the use of occlusal splint reduces EMG activity in the masseter and anterior temporalis muscles, in patients who presented with sleep bruxism related to occupational stress. © 2011 Elsevier Ltd.

Bone defect repair on the alveolar wall of the maxillary sinus using collagen membranes and temporal fascia: an experimental study in monkeys

Few studies has been done using guided bone regeneration in maxillary sinus defects. AIM: To assess the bone repair process in surgical defects on the alveolar wall of the monkey maxillary sinus, which communicates with the sinus cavity, by using collagen membranes: Gen-derm - Genius Baumer, Pro-tape - Proline and autologous temporal fascia. MATERIALS AND METHODS: In this prospective and experimental study, orosinusal communications were performed in four tufted capuchin monkeys (Cebus apella) and histologic analysis was carried out 180 days after. RESULTS: In the defects without a cover (control), bone proliferation predominated in two animals and fibrous connective tissue predominated in the other two. In defects repaired with a temporal fascia flap, fibrous connective tissue predominated in three animals and bone proliferation predominated in one. In the defects repaired with Gen-derm or Pro-tape collagen membranes there was complete bone proliferation in three animals and fibrous connective tissue in one. CONCLUSIONS: Surgical defect can be repaired with both bone tissue and fibrous connective tissue in all study groups; collagen membranes was more beneficial in the bone repair process than temporal fascia or absence of a barrier.

La rinascita del Lido Iride. Progetto di riqualificazione della fascia costiera di Platamona

Questo progetto, maturato in seguito a profonde riflessioni basate sull’analisi e la valutazione della situazione territoriale, è scaturito dalla volontà di fornire una risposta alle carenze funzionali e strutturali di un’area dalle molteplici potenzialità. La fascia costiera di Platamona è stata al centro di progetti di lottizzazione che, invece di tutelare l’aspetto naturalistico e unificare un sistema costiero che si estende per circa otto chilometri, hanno inserito strutture prevalentemente ricettive e turistiche in maniera piuttosto arbitraria e senza tener conto della possibilità di organizzare il progetto d’intervento tramite un apposito strumento urbanistico. Il risultato, un tessuto edilizio disomogeneo e disorganizzato, non contribuisce certo alla volontà di attribuire un carattere e un’identità al luogo; anzi, la frequenza di aree in stato di abbandono, che rischiano di diventare discariche a cielo aperto fa quasi pensare ad una situazione di stallo e di incuria sia da parte delle amministrazioni che dei privati. L’idea del progetto deriva da un approccio che ha come obiettivo il massimo sfruttamento delle risorse locali e il minor impatto possibile sul paesaggio e sul sistema attuale. La volontà è quella di riorganizzare e riqualificare gli spazi più significativi, inserendoli all’interno di un sistema di percorsi e connessioni che vogliono unificare e rendere fruibile l’intero sistema costiero fra Platamona e Marina di Sorso. Inoltre è da rivalutare l’aspetto naturalistico del SIC dello Stagno e Ginepreto di Platamona, un’oasi naturalistica che ha tutte le potenzialità per essere posta al centro di un’attività di ricerca e diventare la meta di un turismo mirato. Nel Piano di gestione dello stagno sono già stati previsti e realizzati percorsi su passerelle in legno che si snodano fra i canneti e la pineta limitrofa, con alcune torrette di avvistamento, attualmente posizionate nella zona a sud. Uno degli obiettivi è dunque quello di completare questi percorsi per gran parte del perimetro dello stagno e di stabilire un percorso ciclo-pedonale ad anello che circondi e renda fruibile l’intera area del SIC. A livello di percorsi e connessioni, oltre alla nuova pista ciclabile che correrà parallelamente alla SP 81, si cercherà di fornire nuovi collegamenti anche all’ambito della spiaggia. L’idea è di costruire una passeggiata sul fronte mare che si articoli con leggere passerelle in legno fra le dune irregolari. Si snoderebbe dalla rotonda di Platamona fino alla piazza di Marina di Sorso, per una lunghezza di circa otto chilometri. Il suo scopo è di rendere fruibile l’intera fascia di spiaggia in modo da evitare un eccessivo calpestio del sistema dunario, che purtroppo risente della forte presenza antropica dei mesi estivi. Nel ripensare questi collegamenti e percorsi, si rende necessaria la creazione di aree di sosta attrezzate che si presentano con una certa periodicità, dettata dai pettini e dalle discese a mare. Vi saranno punti di sosta ombreggiati con alberature, aiuole, sedute, fontane e giochi per bambini. Diventa dunque prioritario il fatto di rendere evidente il concetto di unitarietà del sistema costiero in questione, rendendolo riconoscibile tramite l’organizzazione di spazi, episodi e percorsi. Infine il tentativo che riguarda nello specifico il Lido Iride, è quello relativo al suo recupero. L’intento è di restaurarlo e destinarlo a nuove funzioni ricreative-culturali. La struttura principale è mantenuta invariata, soprattutto le stecche che costituivano le cabine sulla spiaggia (elementi alquanto evocativi e radicati nella memoria del luogo). Il complesso sarà riorganizzato in previsione di ospitare workshop e corsi formativi riguardanti la cultura del mare e della salvaguardia dell’ambiente. Molto attuale e sempre più emergente anche in Sardegna risulta l’archeologia subacquea, a cui sono già state dedicate apposite strutture nelle zone di Cagliari e di Orosei. Dunque si riadatteranno le cabine con lo scopo di farle divenire alloggi temporanei per coloro che seguiranno tali corsi, mentre gli altri edifici del complesso fungeranno da supporto per delle lezioni all’aperto (l’arena e la piscina) e per il ristoro o l’allestimento di spazi espositivi (l’edificio centrale del lido). A causa della posizione del complesso balneare (a ridosso della spiaggia) si presuppone che il suo utilizzo sarà prevalentemente stagionale; perciò si è pensato di fornire una struttura di supporto e d’ausilio, la cui fruizione sia auspicabile anche nei mesi invernali: il Nuovo Centro Studi di Platamona. Questo nuovo complesso consiste in una struttura dotata di laboratori, aule conferenze, alloggi e ristorante. Si attesterà sul fronte mare, seguendo la direttrice del nuovo camminamento e innalzandosi su piattaforme e palafitte per non essere eccessivamente invasivo sul sistema dunario. Consisterà in due edifici di testata alti rispettivamente tre e quattro piani, ed entrambi avranno la peculiarità di avere il basamento aperto, attraversato dall’asse della passeggiata sul mare. L’edificio a tre piani ospiterà i laboratori, l’altro il ristorante. Dietro l’edificio dei laboratori si svilupperà una corte porticata che permetterà di giungere alla sala conferenza. Nella parte retrostante i due edifici di testata saranno distribuiti delle stecche di alloggi su palafitte immerse nel verde, caratterizzate da coperture con volte a botte. Lo stile architettonico del nuovo complesso si rifà all’architettura mediterranea, che s’identifica tramite l’utilizzo di basamenti e piccole aperture in facciata, l’uso di pietre e materiali da costruzioni locali, le bianche superfici che riflettono la luce e il forte segno architettonico dei muri che marcano il terreno seguendone l’orografia fino a diventare un tutt’uno.