- Email: [email protected]
R008: An Animal Model for Frontal Sinus Mucocele Formation
P150
Otolaryngology-Head and Neck Surgery, Vol 137, No 2S, August 2007
R006
linear and angular dimensions of the human face. Morphing software creates a composite image from two facial images by superimposing user-defined registry points. Currently, research has focused exclusively on analysis of frontal facial images. Lateral facial landmarks critical to specify registry points are unknown. First, this study identifies the critical facial landmarks used as registry points to produce lateral facial morphs. Second, the developed methodology was implemented in a pilot investigation aimed to verify whether this approach can create successive generations of morphs. METHODS: To create synthetic lateral facial images, morphing software was used to assign approximately 200 registry points to distinct facial landmarks of lateral images. Each registry point identified a facial feature of one image that was paired with the corresponding feature of the other image. The top 50th percentile of images were randomly morphed to produce the next “attractive” generation. Likewise, the images in the bottom 50th percentile were morphed to produce a new generation of “unattractive” offspring. This process was repeated for five generations. Each generation was posted on an internet-based rating website for one week. The scores were statistically analyzed to determine if the offspring faces maintained scores similar to those of their parents. RESULTS: The proposed registry point selection process produced synthetic morphed images that yielded clear contours on all facial features. Furthermore, the average beauty scores of offspring generations consistently maintained their categorical placement in either attractive or unattractive lateral images. CONCLUSION: The authors successfully produced realistic synthetic lateral images in all generations. The developed method to identify registry points to morph lateral images represents a valid technique to produce lateral images. SIGNIFICANCE: Research indicates that morphing software can be used with lateral photographic analysis as well. SUPPORT: UCI: UROP Research Grant.
Integrin-Expression in Stem Cells for Tissue Engineering Ulrich R Goessler, MD (presenter); Jens Stern-Straeter, MD; Gregor Bran, MD; Haneen Sadick, MD; Karl Hormann, MD; Frank Riedel, MD PROBLEM: The use of adult mesenchymal stem cells (MSC) in cartilage tissue engineering offers new perspectives in the generation of transplants for reconstructive surgery. The extracelular matrix (ECM) plays a key role in modulating function and phenotype of the embedded cells and contains the integrins as adhesion receptors mediating cell-cell- and cell-matrix-interactions. In this study, characteristic changes in integrin expression during the course of chondrogenic differentiation of MSC from bone marrow, cord blood, and adipose tissue were compared. METHODS: MSC were isolated from bone marrow biopsies, cord blood and adipose tissue. During cell culture, chondrogenic differentiation was performed. The expression of integrins and their signaling components were analysed with microarray, RT-PCR and immunohistochemistry in freshly isolated MSC and on the days 1, 2, 5, 10, 20 and 30. RESULTS: The Fibronectin-Receptor (Integrin a5b1) was expressed by undifferentiated MSC, expression rose during chondrogenic differentiation in all 3 types of MSC. The components of the Vitronectin/Osteopontin-Receptors (avb5) were not expressed by freshly isolated MSC, expression started on day 2 and rose until day 10. Receptors for Collagens (a1b1, a2b1, a3b1) were weakly expressed by undifferentiated MSC and were activated from day 5. As intracellular signaling components integrin-linked kinase (ILK) and CD47 showed increasing expression with ongoing differentiation. For all integrins, no significant differences could be found in all 3 types of MSC. CONCLUSION: Integrin-mediated Signaling seems to play an important role in the generation and maintenance of the chondrocytic phenotype during chondrogenic differentiation. Especially the receptors for Fibronectin, Vitronectin, Osteopontin and Collagens might be involved in the generation of the ECM. Intracellularly, their signals might be transduced by ILK and CD47. SIGNIFICANCE: To fully harness the potential of these cells, future studies should be directed to ascertain their cellular and molecular characteristics for optimal identification, isolation, and expansion.
R007 Morphometric Analysis of Synthetic Lateral Facial Images Koohyar Karimi (presenter); Ali Sepehr, MD; Zlatko Devcic; Brian J Wong, MD PROBLEM: Quantitative approaches in defining facial beauty rely on correlating subjective grading of facial beauty with
R008 An Animal Model for Frontal Sinus Mucocele Formation Stephen C Maturo, MD (presenter); Joseph Brennan, MD; Erik K Weitzel, MD PROBLEM: Demonstrate mucocele formation in goats with occluded nasofrontal ducts. A pilot study was performed to investigate whether a goat is a suitable model for creating frontal sinus fractures, nasofrontal outflow tract occlusion, and mucocele formation. METHODS: Three adult goats underwent frontal sinus anterior table osteoplastic flap creation with identification and occlusion of the nasofrontal outflow tract with frontalis muscle plugging. Three months later the goats were sacrificed and gross examination of the frontal sinus, along with histopathologic confirmation of mucocele formation, was carried out.
Research Posters—Thursday
R009 Rhinoplasty: Improvement of the Internal Nasal Valve Cynthia Nicolau, MD (presenter); Mirian Grupenmarcher, MD PROBLEM: Preservation of internal nasal valve function in primary and secondary rhinoplasty. METHODS: Twenty-nine patients: First group-19 patients with potential obstructive nasal problems after rhinoplasty (narrow nose, short nasal bones), and the second group-10 patients with secondary rhinoplasty who underwent surgical correction by open and closed rhinoplasty, using flaring sutures of upper cartilages associated or not to spreader graft, between Dec. 1, 2005 and July 1, 2006. RESULTS: Flaring sutures improved the cross-sectional areas in rhinometry by 10% in patients with primary rhinoplasty and by 12% in the second group. Spreader grafts combined with flaring sutures by 18%. Mean nasal patency scores improved. CONCLUSION: The simplicity of the flaring suture of upper lateral cartilages along with its potential to minimize the risk of internal valve disturbance (for the noses with a high and narrow roof) justifies, in the experience of the presenters, its use. SIGNIFICANCE: This is a valuable addition to the armamentarium of the closed or open rhinoplasty surgeon: better aesthetic results can be achieved, besides the great functional outcome.
R010 Fibrin Glue Modulates Fat Graft Resorption in Nu/ Nu Mice Michael J Reilly, MD (presenter); Stephen Bradley Baker, MD, DDS; Ali Al-Attar, MD; Michael D Johnson, PhD PROBLEM: Autologous fat grafting is associated with high and unpredictable resorption rates in clinical applications. Fi-
brin Glue (FG) is a surgical tissue adhesive derived from human blood products. It has been shown to be effective as a biologic adjunct in multiple surgical procedures, including skin grafts, local tissue flaps, microvascular anastamoses, dural closures, and nerve repair. The team hypothesized that FG could inhibit resorption of fat grafts in an animal model. METHODS: Human fat from abdominoplasty specimens was implanted into athymic nude mice (nu/nu) with 5 percent fibrin glue. Fat graft resorption was serially evaluated for 16 weeks using three-dimensional ultrasound. Mice were sacrificed, and fat grafts were harvested and stained for histologic analysis. RESULTS: FG affected fat graft resorption rates in athymic nude mice as compared to control subjects. Implanted fat grafts resorbed approximately 87 percent over 16 weeks in the control group and 75 percent in the FG treatment group. Histologic analysis demonstrated a significant difference in graft morphology and cyst formation. CONCLUSION: FG affects resorption rates in this animal model of autologous fat grafting. FG may provide a temporary scaffold in the implanted fat necessary for neoangiogenesis and improved graft survival. Further research is required at the cellular level in order to investigate this possibility. SIGNIFICANCE: Predictable modulation of fat graft resorption may make this the ideal technique for soft tissue volume restoration in the head and neck. SUPPORT: NIH RO3 grant in the name of Dr. Stephen B. Baker, MD, D.D.S.
R011 Donor Site Morbidity with Radial Forearm Free Flap Maya Sardesai, MD (presenter); John H-J Yoo, MD; Jason H Franklin, MD, FRCSC; Connie Wyllie Naftel, MD; Linda Denning; Kevin Fung, MD, FRCS(C) PROBLEM: To comprehensively evaluate long-term quantitative and qualitative donor site morbidity following radial forearm free tissue harvest. METHODS: A single-center prospective cohort study with internal controls was undertaken. Experienced occupational therapists measured active range of motion (ROM) of the elbow, forearm, wrist, and digits preoperatively and at least six months postoperatively. Static grip and pinch strength, hand dexterity, and skin sensation were also evaluated. Qualitative assessment of patient perception was determined using the Michigan Hand Outcomes Questionnaire (MHQ), a validated quality-of-life instrument. Quantitative primary outcome measures were (1) wrist flexion and extension, (2) forearm pronation and supination, and (3) hand dexterity. The qualitative primary outcome measure was overall MHQ score. RESULTS: With respect to quantitative primary outcome measures, a statistically significant reduction in wrist extension
RESEARCH POSTERS
RESULTS: All animals demonstrated mucocele formation on gross examination and histologic sectioning. There was no gross or histological evidence of bony erosion. The nasofrontal outflow tracts remained occluded. CONCLUSION: The study provides a suitable animal model for the investigation of mucocele formation in the frontal sinus. The goat frontal sinus and nasofrontal outflow tracts provides an excellent model for frontal sinus studies as they are comparable in size to humans. The results provide further evidence of mucocele formation with occluded nasofrontal outflow tracts. SIGNIFICANCE: This study provides a suitable animal model for the study of the frontal sinus when there is alteration to the naso-frontal outflow tracts. It is the first designed study in the english literature which demonstrates mucocele formation in the adult goat, an animal with frontal sinuses similar in size and function to that of humans.
P151
Otolaryngology-Head and Neck Surgery, Vol 137, No 2S, August 2007
R006
linear and angular dimensions of the human face. Morphing software creates a composite image from two facial images by superimposing user-defined registry points. Currently, research has focused exclusively on analysis of frontal facial images. Lateral facial landmarks critical to specify registry points are unknown. First, this study identifies the critical facial landmarks used as registry points to produce lateral facial morphs. Second, the developed methodology was implemented in a pilot investigation aimed to verify whether this approach can create successive generations of morphs. METHODS: To create synthetic lateral facial images, morphing software was used to assign approximately 200 registry points to distinct facial landmarks of lateral images. Each registry point identified a facial feature of one image that was paired with the corresponding feature of the other image. The top 50th percentile of images were randomly morphed to produce the next “attractive” generation. Likewise, the images in the bottom 50th percentile were morphed to produce a new generation of “unattractive” offspring. This process was repeated for five generations. Each generation was posted on an internet-based rating website for one week. The scores were statistically analyzed to determine if the offspring faces maintained scores similar to those of their parents. RESULTS: The proposed registry point selection process produced synthetic morphed images that yielded clear contours on all facial features. Furthermore, the average beauty scores of offspring generations consistently maintained their categorical placement in either attractive or unattractive lateral images. CONCLUSION: The authors successfully produced realistic synthetic lateral images in all generations. The developed method to identify registry points to morph lateral images represents a valid technique to produce lateral images. SIGNIFICANCE: Research indicates that morphing software can be used with lateral photographic analysis as well. SUPPORT: UCI: UROP Research Grant.
Integrin-Expression in Stem Cells for Tissue Engineering Ulrich R Goessler, MD (presenter); Jens Stern-Straeter, MD; Gregor Bran, MD; Haneen Sadick, MD; Karl Hormann, MD; Frank Riedel, MD PROBLEM: The use of adult mesenchymal stem cells (MSC) in cartilage tissue engineering offers new perspectives in the generation of transplants for reconstructive surgery. The extracelular matrix (ECM) plays a key role in modulating function and phenotype of the embedded cells and contains the integrins as adhesion receptors mediating cell-cell- and cell-matrix-interactions. In this study, characteristic changes in integrin expression during the course of chondrogenic differentiation of MSC from bone marrow, cord blood, and adipose tissue were compared. METHODS: MSC were isolated from bone marrow biopsies, cord blood and adipose tissue. During cell culture, chondrogenic differentiation was performed. The expression of integrins and their signaling components were analysed with microarray, RT-PCR and immunohistochemistry in freshly isolated MSC and on the days 1, 2, 5, 10, 20 and 30. RESULTS: The Fibronectin-Receptor (Integrin a5b1) was expressed by undifferentiated MSC, expression rose during chondrogenic differentiation in all 3 types of MSC. The components of the Vitronectin/Osteopontin-Receptors (avb5) were not expressed by freshly isolated MSC, expression started on day 2 and rose until day 10. Receptors for Collagens (a1b1, a2b1, a3b1) were weakly expressed by undifferentiated MSC and were activated from day 5. As intracellular signaling components integrin-linked kinase (ILK) and CD47 showed increasing expression with ongoing differentiation. For all integrins, no significant differences could be found in all 3 types of MSC. CONCLUSION: Integrin-mediated Signaling seems to play an important role in the generation and maintenance of the chondrocytic phenotype during chondrogenic differentiation. Especially the receptors for Fibronectin, Vitronectin, Osteopontin and Collagens might be involved in the generation of the ECM. Intracellularly, their signals might be transduced by ILK and CD47. SIGNIFICANCE: To fully harness the potential of these cells, future studies should be directed to ascertain their cellular and molecular characteristics for optimal identification, isolation, and expansion.
R007 Morphometric Analysis of Synthetic Lateral Facial Images Koohyar Karimi (presenter); Ali Sepehr, MD; Zlatko Devcic; Brian J Wong, MD PROBLEM: Quantitative approaches in defining facial beauty rely on correlating subjective grading of facial beauty with
R008 An Animal Model for Frontal Sinus Mucocele Formation Stephen C Maturo, MD (presenter); Joseph Brennan, MD; Erik K Weitzel, MD PROBLEM: Demonstrate mucocele formation in goats with occluded nasofrontal ducts. A pilot study was performed to investigate whether a goat is a suitable model for creating frontal sinus fractures, nasofrontal outflow tract occlusion, and mucocele formation. METHODS: Three adult goats underwent frontal sinus anterior table osteoplastic flap creation with identification and occlusion of the nasofrontal outflow tract with frontalis muscle plugging. Three months later the goats were sacrificed and gross examination of the frontal sinus, along with histopathologic confirmation of mucocele formation, was carried out.
Research Posters—Thursday
R009 Rhinoplasty: Improvement of the Internal Nasal Valve Cynthia Nicolau, MD (presenter); Mirian Grupenmarcher, MD PROBLEM: Preservation of internal nasal valve function in primary and secondary rhinoplasty. METHODS: Twenty-nine patients: First group-19 patients with potential obstructive nasal problems after rhinoplasty (narrow nose, short nasal bones), and the second group-10 patients with secondary rhinoplasty who underwent surgical correction by open and closed rhinoplasty, using flaring sutures of upper cartilages associated or not to spreader graft, between Dec. 1, 2005 and July 1, 2006. RESULTS: Flaring sutures improved the cross-sectional areas in rhinometry by 10% in patients with primary rhinoplasty and by 12% in the second group. Spreader grafts combined with flaring sutures by 18%. Mean nasal patency scores improved. CONCLUSION: The simplicity of the flaring suture of upper lateral cartilages along with its potential to minimize the risk of internal valve disturbance (for the noses with a high and narrow roof) justifies, in the experience of the presenters, its use. SIGNIFICANCE: This is a valuable addition to the armamentarium of the closed or open rhinoplasty surgeon: better aesthetic results can be achieved, besides the great functional outcome.
R010 Fibrin Glue Modulates Fat Graft Resorption in Nu/ Nu Mice Michael J Reilly, MD (presenter); Stephen Bradley Baker, MD, DDS; Ali Al-Attar, MD; Michael D Johnson, PhD PROBLEM: Autologous fat grafting is associated with high and unpredictable resorption rates in clinical applications. Fi-
brin Glue (FG) is a surgical tissue adhesive derived from human blood products. It has been shown to be effective as a biologic adjunct in multiple surgical procedures, including skin grafts, local tissue flaps, microvascular anastamoses, dural closures, and nerve repair. The team hypothesized that FG could inhibit resorption of fat grafts in an animal model. METHODS: Human fat from abdominoplasty specimens was implanted into athymic nude mice (nu/nu) with 5 percent fibrin glue. Fat graft resorption was serially evaluated for 16 weeks using three-dimensional ultrasound. Mice were sacrificed, and fat grafts were harvested and stained for histologic analysis. RESULTS: FG affected fat graft resorption rates in athymic nude mice as compared to control subjects. Implanted fat grafts resorbed approximately 87 percent over 16 weeks in the control group and 75 percent in the FG treatment group. Histologic analysis demonstrated a significant difference in graft morphology and cyst formation. CONCLUSION: FG affects resorption rates in this animal model of autologous fat grafting. FG may provide a temporary scaffold in the implanted fat necessary for neoangiogenesis and improved graft survival. Further research is required at the cellular level in order to investigate this possibility. SIGNIFICANCE: Predictable modulation of fat graft resorption may make this the ideal technique for soft tissue volume restoration in the head and neck. SUPPORT: NIH RO3 grant in the name of Dr. Stephen B. Baker, MD, D.D.S.
R011 Donor Site Morbidity with Radial Forearm Free Flap Maya Sardesai, MD (presenter); John H-J Yoo, MD; Jason H Franklin, MD, FRCSC; Connie Wyllie Naftel, MD; Linda Denning; Kevin Fung, MD, FRCS(C) PROBLEM: To comprehensively evaluate long-term quantitative and qualitative donor site morbidity following radial forearm free tissue harvest. METHODS: A single-center prospective cohort study with internal controls was undertaken. Experienced occupational therapists measured active range of motion (ROM) of the elbow, forearm, wrist, and digits preoperatively and at least six months postoperatively. Static grip and pinch strength, hand dexterity, and skin sensation were also evaluated. Qualitative assessment of patient perception was determined using the Michigan Hand Outcomes Questionnaire (MHQ), a validated quality-of-life instrument. Quantitative primary outcome measures were (1) wrist flexion and extension, (2) forearm pronation and supination, and (3) hand dexterity. The qualitative primary outcome measure was overall MHQ score. RESULTS: With respect to quantitative primary outcome measures, a statistically significant reduction in wrist extension
RESEARCH POSTERS
RESULTS: All animals demonstrated mucocele formation on gross examination and histologic sectioning. There was no gross or histological evidence of bony erosion. The nasofrontal outflow tracts remained occluded. CONCLUSION: The study provides a suitable animal model for the investigation of mucocele formation in the frontal sinus. The goat frontal sinus and nasofrontal outflow tracts provides an excellent model for frontal sinus studies as they are comparable in size to humans. The results provide further evidence of mucocele formation with occluded nasofrontal outflow tracts. SIGNIFICANCE: This study provides a suitable animal model for the study of the frontal sinus when there is alteration to the naso-frontal outflow tracts. It is the first designed study in the english literature which demonstrates mucocele formation in the adult goat, an animal with frontal sinuses similar in size and function to that of humans.
P151