Hydroxyapatite Cement in Craniofacial Reconstruction

Verret, D. J.; Ducic, Yadranko; Oxford, Lance; Smith, Jesse E.

doi:10.1016/j.otohns.2005.09.001

Cited by 97 publications

(68 citation statements)

References 13 publications

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“…More recently, alloplastic materials, such as hydroxyapatite and carbonated apatite, have found favor in anterior table reconstruction. 16,58,59,65,66 They provide for easy on-table contouring and avoid donorsite morbidity. However, they are nonvascularized foreign materials that may predispose an already vulnerable area to reinfection.…”

Section: Plastic and Reconstructive Surgery • March 2009mentioning

confidence: 99%

Definitive Treatment of Persistent Frontal Sinus Infections: Elimination of Dead Space and Sinonasal Communication

Rodriguez

Stanwix

Nam

et al. 2009

Plastic and Reconstructive Surgery

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Radical débridement, meticulous removal of the tenacious sinus mucosa, and reconstruction with a free fibular flap in a single stage is a superb choice for eliminating persistent infectious complications associated with frontal sinus fractures in patients who have failed conventional management. The fibular flap provides a secure horizontal buttress, seals the nasofrontal outflow tract with vascularized muscle, and obliterates dead space.

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Section: Plastic and Reconstructive Surgery • March 2009mentioning

confidence: 99%

Definitive Treatment of Persistent Frontal Sinus Infections: Elimination of Dead Space and Sinonasal Communication

Rodriguez

Stanwix

Nam

et al. 2009

Plastic and Reconstructive Surgery

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“…Cranioplasty is often associated with a complication rate of 10-22.5 % [22][23][24][25]. Most of their complications were in cases involving frontal sinus and patients who had undergone irradiation.…”

Section: Discussionmentioning

confidence: 99%

Cranioplasty of Hemispherical Defects Using Calcium Phosphate Cements Along with Titanium Mesh: Our Experience

Kumar

Sudeep

Balwan

2015

J. Maxillofac. Oral Surg.

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Introduction Cranial defects may arise due to trauma, infection, surgical ablation or errors in development. Restoration of such defects is important for esthetics, function and morale of the patient. Several materials are available. Each has its advantages and disadvantages. Search is on for an ideal material. Autogenous grafts remain the gold standard in reconstruction of such defects. However, the morbidity associated with their harvest, additional time required, the need for a second surgical site and the limited supply has led to the search for newer substitutes. Although many materials are available today including biologic and non biologic substitutes, there is still no consensus about the best material. In this article we describe our use of calcium phosphate cements for reconstruction of hemispherical cranial defects. Materials and Methods Cases requiring reconstruction of hemispherical cranial defects (more than 15 cm in any dimension) were selected for study. After exposing the defect under GA, titanium mesh was adapted to the defect for support. Then the calcium phosphate cement was prepared and injected on the mesh to establish good contour. The alloplastic insert in each patient was evaluated for: (a) Immediate post-operative complications (b) Restoration of contour and soft tissue support (c) New bone formation ascertained on HRCT at the end of 2 years. Patients were examined on postoperative first week, at 3 and at 6 months.High resolution computed tomography scans were taken at 2 years postop. There were two female and three male patients. Results There were no complications in the post operative period. The general condition of the patients improved post operatively. Even though the cements maintained their contour at 2 years, there were no signs of bone formation within the cement. Conclusion Calcium phosphate cement is a good bone substitute for use in cranioplasty. In defects requiring mechanical strength, it should be supported by a titanium mesh. It retains the contour but is not replaced by bone even after 2 years.

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“…2,4,52,56 There has been evidence of integration of new bone into the HAC at the periphery of the lesion with no foreign body reaction or inflammatory response, even in animal models. In a series of 54 patients with HAC, Arriaga and Chen 2 reported a reduction in CSF leak from 12.5% to 3.7% when compared with a similar-sized cohort in which only autologous fat was used.…”

Section: Discussionmentioning

confidence: 99%

Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh–hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma

Manjila¹,

Weidenbecher

Semaan

et al. 2013

JNS

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PostoPerative CSF leak after translabyrinthine surgery for removal of an acoustic neuroma (TLAN) is recognized as an infrequent complication, despite the best prophylactic techniques currently available. [29][30][31][32][33]36,40,44 To prevent postoperative CSF leaks after TLAN, several surgical methods have been tried, using different autografts and allografts, alone or in combinations, with varying success rates. 6,8,10,11,13,[22][23][24]27,28,42,46 These range from calvarial bone autografts, bone cements, metals, and resins to resorbable bone plates. 5,6,51 Calvarial grafts can be time consuming and less malleaPrevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh-hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma Object. Several prophylactic surgical methods have been tried to prevent CSF leakage after translabyrinthine resection of acoustic neuroma (TLAN). The authors report an improvised technique for multilayer watertight closure using titanium mesh-hydroxyapatite cement (HAC) cranioplasty in addition to dural substitute and abdominal fat graft after TLAN.Methods. The study was limited to 42 patients who underwent TLAN at University Hospitals Case Medical Center using this new technique from 2006 to 2012. Systematic closure of the surgical wound in layers using temporalis fascia, dural substitute, dural sealant, adipose graft, titanium mesh, and then HAC was performed in each case. Temporalis muscle and eustachian tube obliteration were not used. The main variables studied were patient age, tumor size, tumor location, cosmetic outcome, length of hospitalization, and the incidence of CSF leak, pseudomeningocele, and infection.Results. Excellent cosmetic outcome was achieved in all patients. There were no cases of postoperative CSF rhinorrhea, incisional CSF leak, or meningitis. Cosmetic results were comparable to those achieved using HAC alone. This cost-effective technique used only a third of the HAC required for traditional closure in which the entire mastoid defect is filled with cement, predisposing to infection. Postoperative CT and MRI showed excellent bony contouring and dural reconstitution, respectively.Conclusions. The authors report on successful use of titanium mesh-HAC cranioplasty in preventing postoperative CSF leak after TLAN in all cases in their series. The titanium mesh provides a well-defined anatomical dissection plane that would make reoperation easier than working through scarred soft tissue. The mesh bolsters the fat graft and keeps HAC out of direct contact with mastoid air cells, thereby reducing the risk of infection. The cement cranioplasty does not preclude subsequent implantation of a bone-anchored hearing aid.

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Hydroxyapatite Cement in Craniofacial Reconstruction

Cited by 97 publications

References 13 publications

Definitive Treatment of Persistent Frontal Sinus Infections: Elimination of Dead Space and Sinonasal Communication

Definitive Treatment of Persistent Frontal Sinus Infections: Elimination of Dead Space and Sinonasal Communication

Cranioplasty of Hemispherical Defects Using Calcium Phosphate Cements Along with Titanium Mesh: Our Experience

Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh–hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma

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