Tissue-engineered mucosa graft for reconstruction of the intraoral lining after freeing of the tongue: A clinical and immunohistologic study

Purpose: This article describes the use of tissue-engineered mucosal grafts instead of split-thickness skin grafts after freeing of the tongue in pati ents who had previous resection of an oral squamous cell carcinoma and init ial primary wound closure. Patients and Methods: Tissue-engineered mucosal grafts, up to 75 cm(2) in s ize, were cultured from biopsy specimens of the hard palate in 6 patients, starting 3 to 4 weeks before the operation. After freeing of the tongue, th e engineered mucosa was implanted on the wound surface by using vaseline ga uze as carrier and fixed with an intraoral gauze wound dressing. Results: A good glossoalveolar sulcus was formed in 5 patients, resulting i n good mobility of the tongue and a satisfactory denture-bearing surface. I n 1 patient, there was a disturbance of wound healing, leading to severe sh rinkage of the glossoalveolar sulcus and very limited improvement in tongue mobility. Preoperative bromodeoxyuridine (BrdU) labeling of the graft and postoperative immunohistochemical staining of biopsy specimens from the gra fted areas with anti-BrdU showed that the cultured cells are integrated int o the newly formed mucosal epithelium. Postoperative histologic investigati ons showed a differentiation process in the grafted mucosal epithelium, wit h a change in the expression of cytokeratins. At 6 months postoperatively, the typical pattern of normal nongrafted mucosa was regained. Conclusions: This in investigation provides evidence that tissue-engineered mucosal cells can serve as a graft for large intraoral wounds. Complete in traoral lining is quickly reestablished, and normal epithelial differentiat ion is seen in the graft area within a 6-month postoperative period. (C) 20 01 American Association of Oral and Maxillofacial Surgeons.