Use of Fast-Setting Hydroxyapatite Cement for Secondary Craniofacial Contouring

Abstract

Patients who have previously had surgical correction of major craniofacial deformities will often have residual contour deformities they wish to have improved at a later date. The development of hydroxyapatite cement has simplified these procedures. The setting time is reduced to 5 to 8 minutes by mixing the cement with a phosphate-based solution, increasing the tensile strength, and maintaining the same biocompatibility and osseoconductivity. This study includes 48 patients who presented with a variety of residual contour irregularities secondary to a craniofacial congenital anomaly or a posttraumatic defect. All but one of the patients with congenital craniofacial conditions had their initial surgical correction performed by the senior author (Magee) and had regular follow-up visits. Variable amounts of hydroxyapatite cement were used according to the size of the defect to be corrected. Five patients had a postoperative complication: two infections, one seroma, one persistent swelling, and one drain retention. Patients were followed from 6 months to 3 years (mean, 1 year 5 months). Good results were achieved in 38 patients, acceptable results with minor asymmetries were seen in seven patients, and three other patients required a second intervention to obtain a better contour. Cranioplasty with fast-setting hydroxyapatite cement is a simple and reliable procedure, with a low complication rate. Attention to simple technical and operative principles can provide excellent results.

Prevention of Temporal Depression That Follows Fronto-orbital Advancement for Craniosynostosis

“…Magee and colleagues described 48 postoperative patients who presented with hollowed temporal areas, frontal asymmetry or recession, and other contour deformities. 16 The cause of the temporal deformity that follows fronto-orbital advancement is controversial. Several studies have implicated the temporal fat pad.…”

Bone tissue substitutes and replacements

“…Others have found lower complication rates, with the proper selection of patients and placement, on the order of 5-14% [7][8][9]. Verret et al [10] performed one of the largest reviews of 102 patients undergoing craniofacial reconstruction using bone cement.…”

Effect of calcium carbonate on hardening, physicochemical properties, and in vitro degradation of injectable calcium phosphate cements

“…In addition to the hydrolysis reaction of α‐TCP, calcite and monetite are known to react towards apatite, thereby providing an additional source for precipitation of nanosized apatite crystals 6. However, the slow degradation rate with limited bone ingrowth at osseous sites is the major disadvantage of the cement 7, 8. Recently, our group showed that α‐TCP‐based cement (85% α‐TCP, 10% CaHPO 4 , 5% pHA) containing polymeric microspheres were hardly degradable upon implantation in cranial defects in rats and femoral condylar defects in rabbits even after 12 weeks of implantation 8, 9…”