Gm. Raghoebar et al., USE OF CULTURED MUCOSAL GRAFTS TO COVER DEFECTS CAUSED BY VESTIBULOPLASTY - AN IN-VIVO STUDY, Journal of oral and maxillofacial surgery, 53(8), 1995, pp. 872-878
Purpose: In oral and maxillofacial surgery palatal mucosal grafts are
routinely used to cover mucosal defects caused by vestibuloplasty. How
ever, the quantity of palatal mucosa is a limiting factor in more exte
nsive operations. This study investigated whether autologous cultured
sheets of mucosa can serve as a dressing for these wounds. Materials a
nd Methods: Punch biopsies (diameter, 4 mm) were taken from the hard p
alate of eight patients (five men, three women; mean age 43 years). Ep
ithelial cells were enzymatically dissociated from these tissue specim
ens and grown in vitro in the presence of a fibroblast feeder layer. W
ithin 3 weeks, a transplantable epithelial sheet of about 20 cm(2) was
obtained. The sheet was detached from the culture flask by enzyme tre
atment and fixed to a carrier of Vaseline (Cheeseborough Ponds Inc, Gr
eenwich, CT) gauze. Using a split-mouth technique, the sheet was place
d on half of a mucosal defect created by vestibuloplasty, while the ot
her half of the defect was covered by a conventional split-thickness p
alatal graft. Both the cultured and conventional graft were held in pl
ace by the patient's relined denture fixed with perimandibular sutures
. One week postsurgery, the denture and Vaseline gauze were removed. T
hree months after vestibuloplasty, biopsy specimens of each grafted si
te were taken and processed for light and transmission electron micros
copy (LM, TEM). Results: Three months postsurgery, the grafted mucosa
of both sites bore close resemblance to palatal mucosa. Both the cultu
red and split-thickness grafts were vascularized, did not evoke a homo
graft reaction, and showed a smooth graft/lip mucosal junction and min
imal wound contraction. LM and TEM revealed that both types of grafts
formed a fully differentiated keratinizing mucosa with a well-develope
d basement membrane and rete ridges, comparable with the histology and
ultrastructure of palatal mucosa in situ. Conclusion: It was conclude
d from this study that cultured mucosa can serve as a proper dressing
for mucosal defects after vestibuloplasty.