Herbst Treatment as an Alternative to Surgical Treatment

This lecture is based on a histomorphometric and scanning electron microscopy study of human condylar cartilage and bone tissue changes in relation to age. Its aim is to determine the possibility of stimulated adaptive growth in human condylar cartilage and bone tissue changes in relation to age in a larger sample of human autopsy condyles. Human condylar cartilage and bone were examined in an autopsy material comprising 20 individuals aged 18-31 years. The condyles were embedded in methylmetacrylate and cut on a microtome and stained. Histomorphometry, scanning electron microscopy and cartilage histology were used to analyse the tissue. The fibrocartilage could clearly be described in four zones: the hypertropic zone with `caught´ hypertropic chondrocytes, the hypertropic zone of chondrocytes arranged in columns, the proliferative zone, and the fibrous zone with collagen fibres. Chondrocytes could bee seen `caught´ in the underlying cancellous bone tissue with remodelling activity. There was a statistically significant correlation between age and the fibrocartilage thickness, between age and the hypertropic chondrocytes, and between age and the hypertropic chondrocytes in bone. In conclusion, quantitative and qualitative investigations of the turnover activity in the fibrocartilage and the bone tissue indicated condylar growth potential in the age group until 31 years of age. The growth activity seemed to decline with age. The results show possibilities for biomechanical growth stimulation of the condylar tissue, ie. Herbst treatment as an alternative to surgical treatment. A clinical Herbst treated case in adulthood will end up the lecture presentation.

Learning Objectives:

• Discuss histomorphometric and scanning electron microscopy study of human autopsy condylar cartilage and bone tissue changes in relation to age.
• Interpret whether there are any active cells after 20 years in the condyles.
• Apply knowledge about clinical Herbst treatment of patients, 18-31 years.