Cartilage and bone tissue engineering for reconstructive head and neck surgery

Abstract

The loss of cartilage and bone because of congential defects, trauma and after tumor resection is a major clinical problem in head and neck surgery. The most prevalent methods of tissue repair are through autologous grafting or using implants. Tissue engineering applies the principles of engineering and life sciences in order to create bioartificial cartilage and bone. Most strategies for cartilage tissue engineering are based on resorbable biomaterials as temporary scaffolds for chondrocytes or precursor cells. Clinical application of tissue-engineered cartilage for reconstructive head and neck surgery as opposed to orthopedic applications has not been well established. While in orthopedic and trauma surgery engineered constructs or autologous chondrocytes are placed in the immunoprivileged region of joints, the subcutaneous transplant site in the head and neck can lead to strong inflammatory reactions and resorption of the bioartificial cartilage. Encapsulation of the engineered cartilage and modulation of the local immune response are potential strategies to overcome these limitations. In bone tissue engineering the combination of osteoconductive matrices, osteoinductive proteins such as bone morphogenetic proteins and osteogenic progenitor cells from the bone marrow or osteoblasts from bone biopsies offer a variety of tools for bone reconstruction in the craniofacial area. The utility of each technique is site dependent. Osteoconductive approaches are limited in that they merely create a favorable environment for bone formation, but do not play an active role in the recruitment of cells to the defect. Delivery of inductive signals from a scaffold can incite cells to migrate into a defect and control the progression of bone formation. Rapid osteoid matrix production in the defect site is best accomplished by using osteoblasts or progenitor cells.

Differences in Cartilage-Forming Capacity of Expanded Human Chondrocytes from Ear and Nose and Their Gene Expression Profiles

“…research has been performed on cartilage regenerative medicine in this specialty (34,43). However, recent developments such as the first patient receiving a tissueDevelopments in regenerative medicine offer promise for the reconstruction of damaged tissues and organs, engineered trachea (23) and the clinical application of cultured autologous auricular chondrocytes to treat craincluding cartilage (40).…”

Mold-Shaped, Nanofiber Scaffold-Based Cartilage Engineering Using Human Mesenchymal Stem Cells and Bioreactor

“…The most common need for cartilage in the head and neck area is in the reconstruction of the nose, the ears and tracheal defects, which can be caused either congenitally, or by trauma or surgical resection [2]. Compared to orthopaedic applications, most of the cartilage grafts utilized in facial surgery are implanted subcutaneously, and must exhibit well-defined shape, thickness, and initial mechanical strength.…”

Applied Basic Science of the Auricular Cartilage

“…Thus, the scarring occurred on both sides of the junction and therefore, the junction was in most cases, fibrous and not cartilaginous. In addition, the subcutaneous transplant site in the head and neck lead to strong inflammatory reactions and resorption of the bioartificial cartilage in contrast to orthopedic and trauma surgery where the engineered constructs or autologous chondrocytes are placed in the immunoprivileged region of joints [51].…”