We have been successful in the ex vivo production of an oral mucosa equivalent (EVPOME) using autogenous oral keratinocytes stratified onto a human acellular dermis, AlloDerm, in a serum-free culture system without a feeder layer.
Intraoral grafting of EVPOME was initiated on November 2000 at Niigata University Medical and Dental Hospital, Niigata City, Japan, after gaining informed consent under the approval of institutional review board of Dental School Niigata University. All subjects were selected from patients diagnosed with premalignant lesion or oral cancer who were to undergo surgical excision of the lesion followed by reconstruction. In this preliminary clinical study, EVPOME resulted in a more favorable wound healing response than AlloDerm alone). We therefore had further performed clinical application of EVPOME in another 106 patients at Niigata University Medical and Dental Hospital, Kobe University Hospital, and Toyama University Hospital, supported by a Grant for the Development of Highly Advanced Medical Technology B from the Ministry of Education, Culture, Sports, Science, and Technology of Japan from 2002 to 2004. The main objective of my presentation is to evaluate a total of 112 patients were tried to use EVPOME from November 2000 to March 2006 at the above mentioned three institutions for reconstruction of oral mucosa defects to elucidate the effectiveness of EVPOME.
Patients and methods
In the out patient clinic, a 5 x 5 mm punch biopsy of keratinized oral mucosa was taken 3 to 4 weeks prior to surgery. Oral keratinocytes were then expanded in a serum free culture medium. When a sufficient number of oral keratinocytes had been harvested, cells were seeded onto the AlloDerm to fabricate EVPOME. We evaluated 112 patients that tried EVPOME grafting from November 2000 to March 2006 at the above mentioned three institutions.
Results
A total of 94 patients were grafted EVPOME (grafted group) while 18 patients finally were not grafted EVPOME despite taking a punch biopsy (non-grafted group). They included 40 males and 54 females in the grafted group. Fifty-seven patients used EVPOME at either leukoplakia or carcinoma excision and 21 patients were used at either alveoloplasty or mucogingival surgery. The grafts took well clinically and developed into almost normal oral mucosa in all cases. There were 13 males and 5 females in the non-grafted group.
Discussion
Our findings indicate that EVPOME is useful for the reconstruction of oral mucosa defects which result in a superficial open wound.
References
Izumi et al 1999. 1.Izumi K, Takacs G, Terashi H, Feinberg SE. Ex Vivo Development of a Composite Human Oral Mucosal Equivalent. J Oral & Maxillofac Surg. 1999;57:571–577.
Izumi et al 2000. 2.Izumi K, Terashi H, Marcelo CL, Feinberg SE. Development and Characterization of A Tissue Engineered Human Oral Mucosa Equivalent Produced In A Serum-free Culture System. J Dent Res. 2000;79(3):798–805.
Izumi et al 2003. 3.Izumi K, Feinberg SE, Iida A, Yoshizawa M. Intraoral grafting of an ex vivo produced oral mucosa equivalent: a preliminary report. Int J Oral Maxillofac Surg. 2003;32:188–197.
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