RESUMEN
The purpose of this study was to assess the efficacy of 3-dimensional, printed, patient-specific guides to direct virtual gap arthroplasties that were designed for five patients with advanced unilateral ankylosis of the temporomandibular joint. The guides were used to mimic the intraoperative creation of five preplanned osteotomies, as well as simulating the width and depth of the bone cleavage. The accuracy of the devices in guiding the surgical simulation was assessed by superimposing the preoperative and postoperative computed tomographic scans. The devices were easily put in place with smooth uniform surgical bone cleavage, and favourable postoperative outcomes. The statistical analysis between the planned and surgical gaps, showed that the difference in dimensions was not significant (p=0.1018). The patient-specific gap arthroplasty was neither too near the skull base nor did it jeopardise the height of the mandibular ramus.
Asunto(s)
Anquilosis , Trastornos de la Articulación Temporomandibular , Anquilosis del Diente , Anquilosis/diagnóstico por imagen , Anquilosis/cirugía , Artroplastia , Computadores , Humanos , Osteotomía , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugíaRESUMEN
The increase of cell proliferation during early wound healing is thought to be regulated by a decrease of apoptosis. In contrast, the reduction of cellularity during final wound maturation may be controlled by an increase of apoptotic cell death. Herein we studied whether p53 is involved in wound healing-associated apoptosis and whether transient inhibition of p53 is effective to improve the early healing process of cutaneous wounds. Using intravital microscopic and immunohistochemical techniques in hairless mice, we demonstrated that in vivo inhibition of p53 by pifithrin-alpha (PFT-alpha; 2.2 mg/kg ip) accelerates early epithelialization and neovascularization of cutaneous wounds by (i) promoting leukocyte recruitment, (ii) increasing cell proliferation, and (iii) reducing apoptotic cell death. We further show that final wound closure with down-regulation of cell proliferation is not inhibited by PFT-alpha treatment, indicating that transient blockade of p53 function does not affect the process of wound maturation. Western blot analysis revealed that PFT-alpha lowered nuclear but not cytoplasmic p53, implying that cytoplasmic retention of p53 mediates the antiapoptotic effects of PFT-alpha. Furthermore, PFT-alpha significantly increased expression of proliferating cell nuclear antigen protein in whole extracts of cutaneous tissue and caused a rise in proliferation of wild-type, but not mutant, p53-expressing keratinocytes. From our study we conclude that transient inhibition of p53 supports the early cell proliferation required for rapid tissue repair and that this may represent an attractive approach in the treatment of delayed wound healing.