Kim Jennifer, Hadlock Tessa, Cheney Mack, Varvares Mark, Marler Jennifer
Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
Arch Facial Plast Surg. 2003 Sep-Oct;5(5):403-7. doi: 10.1001/archfaci.5.5.403.
Tongue reconstruction represents a difficult reconstructive problem, based on the tongue's complex multimodality function. Existing methods of tongue reconstruction often result in significant deficits in speech and deglutition. A functional neotongue requires adequate soft tissue bulk and restoration of coordinated muscle function. Tissue engineering, a scientific approach that allows introduction of isolated cell populations of interest within 3-dimensional polymer scaffolds to create new tissue, may allow the generation of more highly functional tissue in tongue reconstruction.
To apply muscle-tissue engineering techniques in the reconstruction of partial glossectomy defects in rats, and to compare the gross and histological nature of tissue found after reconstruction of the hemiglossectomy defect with acellular vs tissue-engineered composite material.
Thirty mature Lewis rats underwent a left-sided mucosa-sparing partial glossectomy. The defects were then filled with 1 of the following 3 substances: isotonic sodium chloride solution, a collagen-rich hydrogel, or hydrogel containing a suspension of neonatal myoblasts from syngeneic rats. The animals were killed after 6 weeks and the tongues were harvested. The control and operated-on tongue halves were evaluated for weight differences and histological features.
The group receiving the hydrogel-myoblast composite injections demonstrated a statistically significant increase in tongue weight of the operated-on side compared with the control side. In contrast, the isotonic sodium chloride solution and hydrogel groups demonstrated loss of tongue weight. These findings correlated with the results of the histological evaluation. Hemitongues from the composite group demonstrated formation of new tissue with areas of musclelike tissue extending from islands of residual hydrogel, and we found evidence of neovascularization and possible neurotization. In contrast, the isotonic sodium chloride solution group exhibited dense fibrous scar with loss of muscle architecture and dramatic loss of tongue volume. The hydrogel group demonstrated preservation of tongue volume with persistent islands of gel, but no clear evidence of new tissue formation.
The introduction of a hydrogel into the rat hemiglossectomy pocket appears to promote volume preservation and/or muscle regeneration. The addition of myoblasts suspended in collagen gel supports the development of new tissue that preserves weight and volume after hemiglossectomy and may possess muscle properties similar to the tissue desired. This tissue-engineering approach represents a promising new strategy in tongue reconstruction and merits further investigation into the possible functional advantages it offers compared with current techniques.
由于舌头具有复杂的多模态功能，舌重建是一个具有挑战性的重建难题。现有的舌重建方法常常导致言语和吞咽功能出现显著缺陷。功能性新舌需要足够的软组织量以及协调的肌肉功能恢复。组织工程是一种科学方法，可将分离出的目标细胞群体引入三维聚合物支架内以生成新组织，在舌重建中可能有助于生成功能更强大的组织。
将肌肉组织工程技术应用于大鼠部分舌切除术缺损的重建，并比较使用脱细胞材料与组织工程复合材料重建半舌切除术缺损后所发现组织的大体和组织学特征。
30只成年Lewis大鼠接受了左侧保留黏膜的部分舌切除术。然后用以下3种物质之一填充缺损：等渗氯化钠溶液、富含胶原蛋白的水凝胶或含有同基因大鼠新生成肌细胞悬液的水凝胶。6周后处死动物并取出舌头。对对照组和手术侧的半舌进行重量差异和组织学特征评估。
与对照组相比，接受水凝胶-成肌细胞复合注射的组手术侧舌头重量有统计学意义的显著增加。相比之下，等渗氯化钠溶液组和水凝胶组出现了舌头重量减轻。这些发现与组织学评估结果相关。复合材料组的半舌显示出新组织形成，类似肌肉的组织区域从残留水凝胶岛延伸出来，并且发现了新生血管形成和可能的神经化证据。相比之下，等渗氯化钠溶液组表现为致密的纤维瘢痕，肌肉结构丧失，舌头体积显著减小。水凝胶组显示舌头体积得以保留，凝胶岛持续存在，但没有明确的新组织形成证据。
将水凝胶引入大鼠半舌切除术腔隙似乎可促进体积保留和/或肌肉再生。添加悬浮在胶原凝胶中的成肌细胞有助于新组织的发育，该新组织在半舌切除术后可保持重量和体积，并且可能具有与所需组织相似的肌肉特性。这种组织工程方法代表了舌重建中一种有前景的新策略，与当前技术相比，其可能具有的功能优势值得进一步研究。
