This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Oncology  • Head & Neck Cancer  • Cancer Reconstruction of Head & Neck  • Laryngology/ Speech/ Language Pathology  • Neoplasms of Head & Neck  • Otolaryngology/ Head & Neck Surgery, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Mucosal Survival on Porous Titanium

Luuk M. Janssen, MD; Gerjo J. V. M. van Osch, PhD; Jia Ping Li, PhD; Nicole Kops, BSc; Klaas de Groot, PhD; Johannes W. Von den Hoff, PhD; Louw Feenstra, MD, PhD; José A. U. Hardillo, MD, PhD

Arch Otolaryngol Head Neck Surg. 2009;135(5):472-478.

Objective  To investigate whether porous titanium can provide a better support for revascularization of a mucosal graft ideal for tracheal reconstruction. In patients with laryngotracheal stenosis or tumor, the mucosa with supporting structures can be damaged, resulting in a defect that has to be reconstructed. Autologous tissues like cartilage and mucosa have been used for reconstruction. The main problem has been incomplete mucosal reepithelialization.

Design  In the first experiment, porous titanium or ear cartilage was combined with mucosa and implanted subcutaneously in athymic mice for different periods of time. In the second experiment, using rabbits, surgically created defects were reconstructed with porous titanium and mucosa on a pedicled fascia flap using a 2-stage procedure. The implants were analyzed with emphasis on angiogenesis and mucosal survival.

Subjects  Male New Zealand white rabbits and nude athymic mice (BALB-c nu/nu).

Results  Normal mucosa having a submucosal layer with vital cells was noted on top of the titanium. Multiple blood vessels were observed extending from the muscle layer through the titanium. Cytokeratin expression was detected in the suprabasal and basal layers of the mucosal epithelium. In contrast, the mucosa on cartilage showed no vital cells and no cytokeratin expression. In the rabbit experiment, all animals survived the reconstruction. The titanium was well integrated to the adjacent tracheal cartilage and surrounding tissues, supporting a fully vital mucosa.

Conclusions  Porous titanium is an inert biomaterial that provides support and allows easy revascularization of a mucosal graft. Titanium, in combination with viable autologous tissues, is a good alternative for tracheal reconstruction.

Author Affiliations: Departments of Otorhinolaryngology (Drs Janssen, van Osch, Feenstra, and Hardillo) and Orthopedics (Dr van Osch and Ms Kops), Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Institute for Biomedical Technology, Twente University, Bilthoven, the Netherlands (Drs Li and de Groot); PoroGen, Enschede, the Netherlands (Dr Li); and Department of Orthodontics and Oral Biology, Radboud University, Nijmegen Medical Centre, Nijmegen, the Netherlands (Dr Von den Hoff).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?