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Biomedical subjects

M Miloro

Publications and source records attributed to M Miloro.

At least 19 recordsLinked to original sources
PubMed2000

Expanded polytetrafluoroethylene entubulation of the rabbit inferior alveolar nerve.

OBJECTIVE: The purpose of this study was to evaluate the use of an expanded polytetrafluoroethylene conduit in the treatment of a 6. 0-mm gap in the rabbit inferior alveolar nerve and compare the results with those of an autogenous interpositional tibial nerve graft. STUDY DESIGN: The inferior alveolar nerves of 5 adult New Zealand White female rabbits (10 nerves) were exposed bilaterally, and a 6-mm segment of each nerve was resected. On one side, chosen at random, the gap was immediately bridged through use of an 8.0 x 2. 0-mm expanded polytetrafluoroethylene conduit; on the other side, the gap was grafted with an autogenous tibial nerve graft. Two randomly selected nerves served as sham-dissected controls. At 15 weeks after surgery, the animals were killed and the entire nerve segments were harvested and prepared according to standard fixation and embedding techniques. The sections were examined histomorphometrically to quantify the degree of axonal regeneration through definition of fascicular number, total fascicular surface area, axonal density, and mean axonal diameter at 3 locations along the repair site. RESULTS: Light microscopic examination revealed the presence of disorganized neural tissue in both groups, with slightly more fibrovascular interfascicular tissue in the expanded polytetrafluoroethylene group. Histomorphometric analysis revealed no significant differences between groups for most of the measured variables. The mean axonal diameter varied between groups, and the fascicular number was greater in the expanded polytetrafluoroethylene group at the middle site. CONCLUSIONS: This study demonstrates that regeneration of the inferior alveolar nerve can occur across a 6.0-mm gap through an expanded polytetrafluoroethylene tube with results comparable to those of an autogenous nerve graft, significant donor site morbidity being avoided. The significant differences between groups were probably due to greater containment of regenerating axonal fibers in the expanded polytetrafluoroethylene group.

Animals↗
PubMed2000

Low-level laser effect on neurosensory recovery after sagittal ramus osteotomy.

OBJECTIVES: This study examined the potential benefit of perioperative and short-term postoperative low-level laser (LLL) therapy on objective and subjective neurosensory recovery after bilateral sagittal split osteotomy surgery. METHODS: Six consecutive patients undergoing bilateral sagittal split osteotomy procedures were enrolled in this prospective study. A complete preoperative clinical neurosensory test, consisting of brush stroke directional discrimination, 2-point discrimination, contact detection, pin prick nociception, and thermal discrimination, was performed on each patient; and a subjective assessment of neurosensory function was made by using a visual analog scale (VAS). The protocol for LLL treatments consisted of real LLL (4 x 6 J per treatment) along the distribution of the inferior alveolar nerve at 4 sites, for a total of 7 treatments, delivered immediately before surgery; at 6 and 24 hours after surgery; and on postoperative days 2, 3, 4, and 7. The clinical neurosensory test and VAS were completed just before each of the treatment sessions and on days 14 and 28, by one examiner. RESULTS: When the results of the patients treated with LLL were compared with published values for neurosensory recovery after orthognathic surgery, there was a significant acceleration in the time course, as well as in the magnitude, of neurosensory return. Brush stroke directional discrimination approached normal values by 14 days, whereas 2-point discrimination and contact detection showed significant improvement at 14 days and returned to near-normal values by 2 months. The results of thermal discrimination and pin prick nociception revealed few neurosensory deficits; however, those patients who were affected showed a slower recovery trend and remained neurosensory-deficient for up to 2 months. The VAS analysis revealed a rapidly progressive improvement in subjective assessment, showing a 50% deficit at 2 days and only a 15% subjective deficit at 2 months. CONCLUSIONS: This study demonstrates that neurosensory recovery after bilateral sagittal split osteotomy procedures can be significantly improved, both in terms of time course and magnitude of return of function, with the adjunctive use of LLL therapy.

Adolescent↗
PubMed1998

The accuracy of clinical neurosensory testing for nerve injury diagnosis.

PURPOSE: The accuracy of the clinical neurosensory test to diagnose trigeminal nerve injuries has never been statistically evaluated. The purpose of this study was to determine the statistical efficacy of the clinical neurosensory test using surgical findings as the "gold" standard, and to determine whether a correlation existed between the sensory impairment score obtained by preoperative testing and the degree of nerve injury found at surgery. MATERIALS AND METHODS: A multisite, randomized, prospective, blinded, clinical trial was conducted on 130 patients with inferior alveolar nerve (IAN) and lingual nerve (LN) injuries. Preoperatively, patients were provided a sensory impairment score using a three-level drop-out clinical neurosensory test (NST), and blind comparisons were made with the surgical findings postoperatively. RESULTS: The positive predictive and negative predictive values for LN-injured patients were 95% and 100%, respectively. The positive predictive and negative predictive values for IAN patients were 77% and 60%, respectively. There were statistically significant differences in the distribution of age, duration of injury, cause of injury, presence of neuropathic pain, presence of trigger pain, and degree of injury between the IAN and LN patient populations. There was a statistically significant positive relationship found between the sensory impairment score and the degree of nerve injury. CONCLUSIONS: The NST is a clinically useful method to diagnose IAN and LN injuries. However, the NST results are less efficient for IAN injuries than LN injuries, and have a high incidence of false-positive (23%) and false-negative (40%) results when testing patients with IAN injuries. The different rates of statistical efficiency between the two groups of patients may be attributable to differences in prevalence and biologic covariates.

Adolescent↗
PubMed1998

Distraction osteogenesis of the mandible with a modified intraoral appliance: a pilot study in miniature pigs.

The purpose of this study was to evaluate an intraoral, nontooth-borne, submucosal distraction appliance in the pig mandible from a clinical, radiographic, and histologic perspective. Intraoral distraction appliances were fabricated, tested for strength, and then adapted and rigidly fixated to the mandibles of three growing miniature Yucatan pigs. A bicortical osteotomy was performed on the right side of the mandible, and a buccal and lingual corticotomy on the left. Two amalgam markers were placed on each side of the osteotomy/corticotomy sites as references. Measurements were taken to evaluate the length and vector of the distraction site, and radiographs were obtained perioperatively. After a latency period of 5 days, distraction was commenced and continued for 13 days at a rate of 1 mm/day. Clinical evidence of distraction was apparent in all cases, with resulting Class III skeletal deformities. Distraction progressed further for the corticotomy sides than the osteotomy sides because of distraction device failure. Radiographic examination revealed increased bone density at the periphery of the distracted callus, with less density apparent centrally. Histologic examination showed fibrous connective tissue in the center of the callus, with cartilage and osteoid formation at the periphery. Bone formation was parallel to the vectors of distraction in all cases. This study confirms that the use of a modified intraoral appliance for distraction osteogenesis is feasible. Use of this device overcomes many of the problems associated with extraoral devices and may have clinical applications.

Animals↗
PubMed1997

Assessment of the lingual nerve in the third molar region using magnetic resonance imaging.

PURPOSE: The purpose of this study was to determine the precise in situ location of the lingual nerve in the third molar region using high-resolution magnetic resonance imaging. PATIENTS AND METHODS: Ten healthy volunteers (20 sides) with mandibular third molars underwent bilateral axial and coronal high-resolution magnetic resonance imaging (MRI) examinations of the posterior mandible and floor of the mouth from the lingula to the mental foramen. Three trained individuals made measurements of each image to determine the vertical and horizontal position of the lingual nerve in the third molar region. RESULTS: The mean vertical (2.75 +/- 0.97 mm [range, 1.52-4.61]) and horizontal (2.53 +/- 0.67 mm [range, 0.00-4.35]) distances to the lingual crest and lingual plate of the mandible were determined. In the third molar region, there were only 2 of 20 cases (10%) in which the nerve was above the lingual crest, and there were 5 of 20 instances (25%) in which the nerve was in direct contact with the lingual plate. CONCLUSIONS: This study precisely documents the in situ location of the lingual nerve in the third molar region, and reconfirms the relative vulnerable position of this structure during third molar surgery.

Adult↗