Much emphasis has been placed on the importance of laying epithelium over the fistula, particularly the epithelium of Shrapnell's membrane. We have reviewed the international literature on the effects of epitheliums on osteogenesis and nowhere find any evidence of an inhibitory effect. On the contrary certain epitheliums, notably of the genitourinary tract, stimulate osteogenesis.1 We have reviewed all available literature on the effects of metals, heat, irradiation, presence of bone ash and other factors on osteogenesis in bone defects. It is our impression that the evidence does not support the claims advanced as to the efficacy of any of these factors in influencing osteogenesis favorably or otherwise in a manner sufficiently clearcut to provide an adequate physiologic basis for an operation to create a fistula. That the operation is successful in some cases is an established fact. But the factors influencing the outcome are too ill understood to insure predictability.
GUGGENHEIM P, GUGGENHEIM L. BONE FISTULA: FURTHER STUDIES. Arch Otolaryngol. 1943;38(2):139–147. doi:10.1001/archotol.1943.00670040150005
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