Histological Evaluation of Mandibular Bone After Mandibular Outer Cortex Osteotomy: The Role of the Periosteum

This study investigates the role of the periosteum in the repair and reconstruction process post-osteotomy using histological analysis to provide insights for pediatric craniofacial surgery.

Twenty-four 3-month-old miniature pigs were divided into 2 groups. Group I: left mandibular outer cortex and periosteum resection + right mandibular outer cortex resection with periosteum preserved. Group II: left mandibular outer cortex and periosteum resection + no surgery on the right side. Excised the incision skin, bilateral masseter muscles, condyles, and mandible at 4, 12, and 24 weeks postoperatively for hematoxylin-eosin staining and immunohistochemical staining of osteoprotegerin, receptor activator for nuclear factor kappa B ligand, bone morphogenetic protein-4, Ki-67, caspase-3, CD3, and CD19.

Hematoxylin-eosin staining showed no significant differences between the left and right incision skin, masseter muscles, and condyles. The periosteum-preserved side showed better bone healing. Immunohistochemical staining showed early osteogenesis and osteoclast activity on the periosteum-resected side were significantly lower than on the periosteum-preserved side, but gradually enhanced during late-stage healing.

The periosteum factor is one of the main reasons for mandibular deviation after mandibular outer cortex osteotomy. The periosteum has a dual role in promoting osteogenesis and limiting excessive bone growth.