The document provides information on bone grafting and reconstruction. It discusses the historical background of bone grafting gaining experience from wars. It then describes the three biological mechanisms involved in bone grafting: osteogenesis, osteoconduction, and osteoinduction. The document proceeds to provide detailed information on the surgical anatomy of potential bone graft harvesting sites, including the rib, iliac crest, and tibia. It describes the structural features and harvesting procedures for each bone.
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University. Numerous etiologies lie behind mandibular defects including pathologic lesions, trauma related, infectious diseases and congenital defects. At present, the methods to restore mandibular defects can be classified into four basic categories:
1.Autogenous bone grafts in the form of nonvascularized free bone transfer, or vascularized tissue transfer, either pedicled or based on microvascular anastomosis
2. Distraction osteogenesis
3. Alloplastic materials (with or without bone)
4. Tissue engineered grafts
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University. Numerous etiologies lie behind mandibular defects including pathologic lesions, trauma related, infectious diseases and congenital defects. At present, the methods to restore mandibular defects can be classified into four basic categories:
1.Autogenous bone grafts in the form of nonvascularized free bone transfer, or vascularized tissue transfer, either pedicled or based on microvascular anastomosis
2. Distraction osteogenesis
3. Alloplastic materials (with or without bone)
4. Tissue engineered grafts
Local & regional flaps /certified fixed orthodontic courses by Indian dental ...Indian dental academy
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Dr Rahul VC Tiwari - Novel Transoral Approach to the Posterolateral Maxilla and Infratemporal Region - 10th jc - DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY - SIBAR INSTITUTE OF DENTAL SCIENCES, GUNTUR
This seminar explains about the development, relations, ligaments, various attachments, vascular and nervous supply and various surgical approaches and its modifications to TMJ
Harvesting of bone from the iliac cres /certified fixed orthodontic courses b...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
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Local & regional flaps /certified fixed orthodontic courses by Indian dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Dr Rahul VC Tiwari - Novel Transoral Approach to the Posterolateral Maxilla and Infratemporal Region - 10th jc - DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY - SIBAR INSTITUTE OF DENTAL SCIENCES, GUNTUR
This seminar explains about the development, relations, ligaments, various attachments, vascular and nervous supply and various surgical approaches and its modifications to TMJ
Harvesting of bone from the iliac cres /certified fixed orthodontic courses b...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Analysis of Cost of Autologous Bone Graft; Podium Presentation; AOFAS Annual ...Erik Harris
This Podium Presentation summarized the initial findings of a study that applied an interactive budget impact model (BIM) to assist surgeons and hospitals with cost/benefit analyses of: 1) incremental costs associated with iliac crest bone graft harvest and local bone graft harvest; 2) additional costs associated with graft site enhancers; and 3) utilization of an orthobiologic bone graft substitute (Β-TCP with rhPDGF-BB) as a replacement of autograft. The objective of the study was to facilitate informed decision-making through the application of comparative clinical and economic value assessments of competing interventions in foot and ankle fusion.
Implant surgeries to overcome anatomic difficulties ii / dental implant cour...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Patient-based learning made simple
Understanding the anatomy of a sports injury is the key to unlocking the diagnosis for most clinicians. Unfortunately, anatomy is often poorly taught, is not clinically focused and many anatomy textbooks are so complicated that searching for clinically useful information is difficult. In addition, multiple pathologies can present in an overlapping fashion, making the differentiation of the various possible causes of injury problematic.
Clinical Sports Anatomy classifies structures according to their anatomical reference points to form a diagnostic triangle. Discriminant questions are coupled with the more useful clinical tests and diagnostic manoeuvres to direct the reader toward a definitive clinical diagnosis. This approach is firmly rooted in evidence-based medicine and includes a list of the most appropriate investigations required to confirm diagnosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Introduction
Historical background:
Surgeons have gained their experience
in reconstruction from the numerous
wars
Civilian injuries produces the largest
number and the most extensive tissue
loss almost indistinguishable from ware
injuries
3. Introduction
It started in WW I and concentrated around
reconstruction of the mandible but without
antibiotic support
In WW II distant bone blocks were transplanted
from the ilium, rib and tibia with routine use of
antibiotic
No cancellous cellular marrow
4. Introduction
Mowlem in 1944, introduced the concept of
“Iliac cancellous bone chips” beginning the
evolution of predictable bony reconstruction of
the jaw bone
Boyne brought about the “use of particulate
bone and cancellous marrow” with metallic
trays splinted to large acellular cortical bone
5. Biology of bone grafting
Three biological mechanism are involved:
Osteogenesis:
Is the production of new bone by proliferation, osteoid production
and mineralization
Osteoconduction:
Is the production of new bone and migration of local
osteocompetent cells along a conduit e.g. fibrin, blood vessel or
even certain alloplast material like hydroxyapatite
Originate from the endostium or residual periostium of the host
bone
Osteoinduction:
Is the formation of bone by stem cells transforming into
osteocompetent cells by BMP
It induct the recipient tissue cells to form periostium and
endostium
7. Surgical anatomy The Rib
The first, eleventh and
twelfth ribs are atypical
A typical rib has a head,
a neck and a shaft.
The shaft slopes down
and laterally to an angle
and then curve forward
The upper border is
blunt and lateral to the
angle the lower border
form a sharp ridge
sheltering a costal
groove
This feature identify
right from left ribs
8. Surgical anatomy The Rib
Typical rib:
The head:
Bevelled by two articular
facets that slope away
from a dividing ridge.
The lower one is vertical
and articulate with the
upper border of its own
vertebra
The upper facets faces
up and articulate with
the lower border of the
vertebra above
Each form a synovial
joint separated by a
ligament attached to the
ridge
9. Surgical anatomy The Rib
The neck:
Is flattened with its upper
border curving into a thin,
prominent ridge, the crest
The tubercle:
Shows two small facets
lying medial and lateral
The medial one is covered
with hyaline cartilage and
form synovial joint with the
transverse process of its
vertebra
The lateral facet is smooth
surfaced and receive the
costotransverse ligament
10. Surgical anatomy The Rib
Costal cartilages:
They form a primary
cartilaginous joints at the
extremities of all twelve
ribs
The first is short and
articulate with the
manubrium and the
clavicle
They increase in length
below and the seventh has
the longest.
They are bend from a
downward slope with the
rib to upward slope toward
the sternum
11. Surgical anatomy The Rib
Rib harvesting:
Indicated for costochondral graft to
restore pseudoarticulation of the TMJ, or
to replace a missing part of the anterior
mandible to reconstruct a functional
articulation
The rib is usually 5th
or 6th
typical one
Incision is placed in the infra-mammary
crease, to hide the scar
12. Surgical anatomy The Rib
Right rib is always preferred because:
It could be contoured to fit either side of
the mandible or facial bones
Postoperative pain is less likely to be
confused with cardiogenic pain
The 6th
rib is where the distal origin of the
pectoralis major muscle, dissection transect the
muscle minimally
Sharp dissection is carried through full thickness
of skin, subcutaneous tissues and the muscle, to
expose the rib periostium, the chest wall cortex
13. Surgical anatomy The Rib
The periostium is incised from 1 cm onto
the rib cartilage to the full desired length,
the anterior border of the latissimus dorsi
muscle, about 12 cm.
Reflected carefully from the chest wall
cortex around the inferior and superior rib
edges to the pleural cortex periostium,
using a maxillofacial surgery periosteal
elevator rather than Doyen rib stripper
14. Surgical anatomy The Rib
This is to avoid creating pleural tear,
because of the irregularities and bony
projection to which periostium and lung
pleura are firmly attached, leading to
pneumothorax
A releasing incision made at right angle
to the rib incision carried to the rib edges
help in reflecting the perichondrium and
gaining access to the cartilage
15. Surgical anatomy The Rib
The cartilage is separated first by scalpel
blade and the proximal part is cut with a
saw or rib cutter after lifting the rib and
carefully separating any adherent
periosteal membrane from the pleural
cortex
The closure is layered, periostium,
subcutaneous tissue, dermis and lastly
skin
Drain is not necessary
16. Surgical anatomy The Rib
The length of the cartilage is related to the growth of
the graft not to the prevention of bony ankylosis
Disadvantages:
Longer length create a longer lever arm, promoting
separation (2-3 mm)
Associated with overgrowth
Incorporation of the perichondrium or periostium
sleeve, in the graft does not enhance survival or
stability of the graft
In children the cartilage is easily separated from
bone, sleeve reduce the chance of separation
In adult the cartilage is firmly incorporated to bone
Increases the probability of pneumothorax
17. Surgical anatomy The Rib
It is recommended, a 2 – 3 mm of
cartilage length without adherent
periostium of perichondrium for both
costochondral growth grafts in
children and articulation graft in adult
19. Surgical Anatomy: Iliac crest
Hip Bone:
Made of three bones
fused in a Y-shaped
epiphysis involving the
acetabulum, (hip joint
socket), a concave
hemisphere,
Pubis and ischium
form incomplete bony
wall for pelvic cavity,
their outer surface gives
attachment to the thigh
muscles
The ilium forms a brim
between the hip joint
and the joint with the
sacrum
20. Surgical Anatomy: Iliac crest
The anterior 2/3 is thin
bone forming the iliac
fossa, posterior
abdominal wall
The posterior 1/3 is
thick bone and carries
the articular surface
for the sacrum
The ilium is nearly at
right angle to the
other two bones
21. Surgical Anatomy: Iliac crest
The outer surface rises
wedge-shaped along an
anterior border to the
anterior superior iliac
spine
Behind the acetabulum,
it passes up as a thick
bar of weight-bearing
bone and curve back to
the posterior superior
iliac spine
It is the attachment of
the muscles of the
buttock, Gluteus
minimus, medius and
maximus
22. Surgical Anatomy: Iliac crest
The upper border between
the anterior and posterior
superior iliac spines , the
iliac crest, has a bold
upward convexity and
curve from front backward
in a sinuous bend
The anterior part is curved
outwards and it’s external
rim has a more prominent
convexity behind the
anterior superior iliac
crest spine, the iliac
tubercle
23. Surgical Anatomy: Iliac crest
The gluteal surface:
Convex in front,
concave behind,
conforming to the
curvature of the iliac
crest
The anterior border:
Shows a gentle S-
shaped bend
Sartorius muscle is
attached a finger
breadth below the
anterior spine
The posterior part of the
crest is thicker than the
rest
24. Surgical Anatomy: Iliac crest
The inner surface:
The iliac fossa, shows
a gentle concavity
and is paper thin in
it’s deepest part
The lower 2/3 is bare
bone
The iliacus muscle
and fascia are
attached to the inner
lip of the crest over
the whole area
25. Surgical Anatomy: Iliac crest
Bone harvesting:
The lateral approach to the anterior ilium
affect the gait the most
The medial anterior approach involve the
large iliacus muscle which is not
necessary for normal gait but large
medial haematoma might produce gait
disturbances
26. Surgical Anatomy: Iliac crest
Surgical access:
Incision should be placed 1 cm posterior to the
anterior superior spine and extend to the iliac
tubercle
It should be placed lateral to the bony
prominence to prevent irritation by tight cloths
or belt
Proceed down to bone medial to the muscles,
tensor fascia lata and gluteus medius and lateral
to the iliacus and the external abdominal
muscles
27. Surgical Anatomy: Iliac crest
Cancellous bone is available in the anterior ilium
within the upper 2 – 3 cm and between the
tubercle and the anterior superior spine, IliacIliac
crest graftcrest graft.
“Trap door” is one of the most common
osteotomy used for anterior ilium harvest
During closure, strict attention should be
followed in order to reorient and reposition the
muscles in their original positions
A drain is required to because of the dead space
and should be placed within the bony cavity
29. Surgical Anatomy: The tibia
Is the largest and
medial bone of the
lower leg, has a large
upper end and a
smaller lower one
The shaft is vertical
and triangular in
cross-section
Its anterior and
posterior borders with
the medial surface
between them are
subcutaneous
30. Surgical Anatomy: The tibia
The anterior border is
sharp above and blunt
below where it
continue with medial
malleolus
The posterior border is
blunt and run down
into the posterior
border of the medial
malleolus
On the fibular side it
has a sharp
interosseous border
31. Surgical Anatomy: The tibia
The upper end:
Expand widely with
prominent
tuberosity
projecting
anteriorly from its
lower part
The surface bone is
a very thin
compact-type which
is fragile around the
margins
32. Surgical Anatomy: The tibia
The superior articular
surface or plateau
shows a pair of
condylar concavity to
articulate with
meniscus and the
condyle of the femur
Between the condylar
surfaces, the plateau
is elevated into
intercondylar
eminence and
grooved by the
medial and lateral
tubercles
33. Surgical Anatomy: The tibia
The lower end:
Is rectangular in section
Medially, it is
subcutaneous, anteriorly,
it is bare bone
Laterally, the surface is
triangular and articulate
with the fibula
The extensive subcutaneous
surface of the tibia makes it
an accessible donor site for
bone grafts
34. Surgical Anatomy: The tibia
Bone harvesting:
The tibial plateau is an excellent reservoir for
cancellous bone
It can provide up to 40 cc of bone without
affecting the structural support of the tibia
Indication:
Small bony defects
Non-union,
Osteotomy defects
Dentoalveolar defects
Sinus lift procedure
35. Surgical Anatomy: The tibia
Surgical access:
Could be done under local anaesthesia and
conscious sedation
Incision over the lateral tubercle best
accomplished by flexing the leg at the knee joint
It is 6 – 10 mm from the skin and dissection is
made through the thin subcutaneous tissue
Sharp dissection to reflect the tensor fascia lata
band and make 1 cm opening into the cortex
and the cancellous bone could be harvested
lateral and inferior to the midline to avoid
damage to the knee