CD34 and CD105 Microvessels in Resected Bone Specimen May Implicate Wound Healing in MRONJ

Clinical treatment outcome of MRONJ (medication-related osteonecrosis of the jaw) surgery despite radical osseous removal and primary closure healing still shows differences in terms of outcome and disease recurrence. The study aims to assess the rate of angiogenesis of MRONJ lesions in order to understand the impact of angiogenesis and neoangiogenesis status on MRONJ surgical treatment outcome. This is the first study correlating microvessel density with prognosis in MRONJ surgically-treated patients. The immunohistochemical expression of CD34 and CD105 in MRONJ specimens obtained from surgically-treated patients was evaluated. The most vascularized areas detected by CD34 and CD105 were selected and the microvessel density value of the samples was registered. Samples were retrospectively divided according to the clinical outcome of MRONJ surgical treatment, dividing patients into two groups, “healed” and “not healed”. Statistical analysis was performed to assess if neovessels could influence treatment outcome in patients undergoing radical surgery. In the examined cohort, this value was highly predictive of better treatment outcome after radical surgery of MRONJ. Understanding of angiogenesis-dependent factors deserves further attention as a future target for MRONJ prevention and therapies.

Bone Chemical Composition Assessment with Multi-Wavelength Photoacoustic Analysis

In this study, the feasibility of assessing the chemical composition in bone using the multi-wavelength photoacoustic analysis (MWPA) method was investigated. By illuminating a bone specimen using laser light with a wavelength tunable over an optical spectrum from 680 nm to 950 nm, the optical absorption spectrum of the bone was acquired. Then, with the optical absorption spectra of all the optically absorbing chemical components in the bone known, a spectral unmixing procedure was performed to quantitatively assess the relative content of each chemical component. The experimental results from porcine rib bones demonstrated that the contents of the chemical components, including not only non-organic materials such as minerals and water but also organic materials including oxygenated hemoglobin, deoxygenated hemoglobin, lipid, and collagen, can all be assessed by MWPA. As the chemical composition in the bone is directly associated with functional and metabolic activities, the finding from this study suggests that the MWPA method could offer a new diagnostic tool for the non-invasive evaluation of bone health.

Effects of a sensory branch to the posterior external ear canal: coughing, pain, Ramsay Hunt's syndrome and Hitselberger's sign

Background:A distinct nerve innervating the external auditory canal can often be identified in close relation to the facial nerve when gradually thinning the posterior canal wall. This nerve has been attributed to coughing during cerumen removal, neuralgic pain, Hitselberger's sign and vesicular eruptions described in Ramsay Hunt's syndrome. This study aimed to demonstrate the origin and clinical impact of this nerve.Methods and results:In patients with intractable otalgia or severe coughing whilst inserting a hearing aid, who responded temporarily to local anaesthesia, the symptoms could be resolved by sectioning a sensory branch to the posterior canal. In a temporal bone specimen, it was revealed that this nerve is predominantly a continuation of Arnold's nerve, also receiving fibres from the glossopharyngeal nerve and facial nerve. Histologically, the communicating branch from the facial nerve was confirmed.Conclusion:Surgeons should be aware of the posterior auricular sensory branch and its clinical implications.

The Effect of Trabecular Bone on the Mechanical Response of Human Mandible with Implant

This study aims to investigate the influence of trabecular bone in human mandible bone on the mechanical response under implant load. Three dimensional voxel finite element (FE) model of mandible bone was reconstructed from micro-computed tomography (CT) images that were captured from bone specimen. Two FE models were developed where the first consists of cortical bone, trabecular bone and implants, and trabecular bone part was excluded in the second model. A static analysis was conducted on both models using commercial software Voxelcon. The results suggest that trabecular bone contributed to the strength of human mandible bone and to the effectiveness of load distribution under implant load.

Incidental Pedal Manifestation of Primary Bone Lymphoma

Primary lymphoma of bone (PLB) is an uncommon entity and is extremely rare in the foot and ankle. In this case, PLB was identified from the bone specimen after a bunionectomy of the first and fifth metatarsals. The diagnosis was confirmed with pathologic analysis, genetic karyotyping, positron emission and computed tomography scans, and fluorescence in situ hybridization (FISH). We felt that reporting this case was essential due to the rarity of its pedal occurrence and the lack of preoperative signs or symptoms.