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Derya Özçelik, MD; Turul Turan, MD; Fevziye Kabukcuolu, MD; Kemal Uurlu, MD; Özcan Öztürk, MD; Muzaffer Baak, MD; Mhjdat Bankaolu, MD

Arch Facial Plast Surg. 2003;5:301-308.

Objectives  Osteogenic properties of the dura and periosteum are thought to contribute to the regenerative capacity of membranous bone tissue. The purpose of this investigation was to elucidate (1) whether dura without underlying neural tissues can induce osteogenesis, (2) to what extent the periosteum participates in membranous bone healing, and (3) the difference between dura-induced and periosteum-induced osteogenesis.

Methods  A standardized 2-mm defect was created within the middle portion of each zygomatic arch in 30 Wistar albino rats. The rats were divided into 3 groups, 10 animals in each group. In group 1, the periosteum was removed and neonatal dura grafts were transplanted onto the zygomatic arch bone defect circumferentially. In group 2, the overlying periosteum was preserved. In group 3, the periosteum was removed. At 3 and 10 weeks, animals from each group were killed, and specimens were obtained. Data were collected from the 3-dimensional computed tomographic scans and histologic studies to compare the extent of bony repair.

Results  Fracture sites demonstrated osteogenesis associated with chondrogenesis in groups 1 and 2 and only limited osteogenesis with no chondrogenesis in group 3. In some animals in group 3, cortical bone ends underwent resorption. In groups 1 and 2, bone defects were obliterated by the formation of the mature compact bone at 10 weeks postoperatively. The difference between bone regeneration in these groups was not significant (P = .16). In group 3, the defects failed to heal by bony union, and in most of the samples the fibrous union was observed instead. The difference between groups 1 and 3 was significant (P = .03). The difference between groups 2 and 3 was not significant (P = .09).

Conclusions  The trend toward significance is in agreement with the current clinical practice of preserving periosteum in the manipulations of the membranous bone defects. Newborn dura can exert a potentiating effect on osteogenesis.

From the Departments of Plastic and Reconstructive Surgery (Drs Özçelik, Turan, and Uurlu), Pathology (Dr Kabukcuolu), and Radiology (Drs Baak and Bankaolu), ili Etfal State Hospital, and Otorhinolaryngology, Istanbul University–Cerrahpaa Medical Faculty, stanbul, Turkey. Dr Özçelik is now with the Department of Plastic and Reconstructive Surgery and Dr Öztürk with the Department of Otorhinolaryngology, Abant zzet Baysal University, Düzce, Turkey.