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Cultured epithelium has proven to be a good grafting material for skin defects. In our experience two kinds of epithelial cells, skin keratinocytes and mucosal cells, have been used to fabricate cultured epithelial sheets and autografted to the patients. Traumatic scars of the face were treated by cultured epidermal epithelium (CEE). The skin graft in the oral cavity was replaced by mucosa using cultured mucosal epithelium (CME). Also, the CME was applied to the skin defects at the donor sites of split-thickness skin grafts. Postsurgical follow-up showed good results. As a result, CME was useful in improving the biological environment around the abutments of dental implants, and it also promoted the re-epithelialization of skin defects. From our investigations, CEE/CME are promising treatment modalities which can reduce pain and speed up the healing process in burn patients. Therefore, cultured epithelium banks are worth establishing for auto- and allografting of skin/mucosal defects.

We investigated morphological changes after transplantation of cultured mucosal epithelium using a modified Barrandon's method (1988). Serially cultivated human mucosal epithelium was transplanted onto the reverse side of rectangular dorsal skin flaps in hairless mice. The morphological changes in the epithelium were studied using paraffin sections. The modified Barrandon's method used in this study has advantages such as minimum external trauma and less chance of infection. The cultured epithelium was taken within 1 week and gradually increased its epithelial thickness. Keratinized epithelium arises after 3 weeks. At 4 weeks after grafting, the grafted epithelium comprised 7-10 cell layers. The structure of transplanted tissue, in conjunction with surrounding connective tissues, showed dermis-like features at day 7 after transplantation. From these results, it was confirmed that cultured mucosal epithelium could be successfully transplanted and its morphology was similar to that of normal mucosal tissue.

Cultured stratified epithelium for grafting was prepared using human keratinocytes. In the field of plastic surgery, many patients who received grafts of cultured epithelium have been reported. However, no case in the maxillofacial region has been reported. Here we report 2 cases of traumatic scars in the maxillofacial region that were treated by cultured epithelium.The patients were a 21-year-old man and a 9-year-old boy who complained of deformity due to a traumatic scar. In both cases, small skin segments, 1-2cm2, were obtained before operation, and epithelial cells were cultured by the methods of Green et al, using 3T3 cells as the feeder layer. After 3 weeks, 175-350cm2 cultured epithelium was prepared. Then, surgical debridment of the scar was carried out, and cultured epithelium was grafted onto the epithelial defects. Cultured epithelium was completely taken within 1 week. Subsequently, that the surface of the graft became smooth and pigmentation faded away.

Many clinical studies have demonstrated the usefwness of cultured epithelial grafts. Recently, cultured epithelium has been preserved by freezing and successfuly grafted after thawing. However, few papers have described morphological changes that occur after freezing cultured epithelium. We studied the morphological changes of cultured mucosal epithelial sheets and cultured epidermal sheets after freezing. In our freezing procedure, glycerin and dimethyl sulfoxide (DMSO) were used as cryoprotectants. Each epithelial sheet was stored for 3 weeks at -80°C or -196°C.The structures of both types of epithelial sheets were generally maintained after freezing storage. However, cultured mucosal epithelium showed mild showing vacuolation around the nuclei after freezing with DMSO.The results indicated that cultured mucosal epithelial sheets can be stored by freezing and that their structure can be maintained by using glycerin.

Rheumatoid arthritis (RA) is a chronic inflammatory disease with immunologic abnormalities. Although the temporomandibular joint (TMJ) can be involved, early changes of the TMJ affected by RA are unclear, and the treatment for temporomandibular disorders (TMD) in patients with RA is not established yet. Physiotherapy is effective for general joints with RA but its effect for RA of the TMJ is unknown. The clinical effects of physiotherapy for TMD in RA patients was investigated. Five patients with RA visited our department with complaints of the TMD. Physiotherapy, including exercises of TMJ movement and mastication training were stasted, bilaterally and simultaneously. Clinical findings showed an increase in maximal interincisal distance with no pain after therapy in 4 patients. No patient had anterior open bite or TMJ ankylosis in the follow-up period (2.5 to 5.3 years). These results suggest that physiotherapy is also effective for the TMD in RA patients.