Associated Titanium Mesh and Native Bone Cranioplasty in Posttraumatic Reconstruction of Frontal Skull Defects

Abstract

Cranioplasty of frontal skull defects are used for cosmetic reasons, helping correct disfigurement, but also play a critical role in protecting intracranial content from exposure and compression. Modern surgical management is based on principles of craniofacial surgery such as early one-stage repair- if possible, exposure of all fracture fragments by well-sited cosmetic incisions, precise internal fixation and definitive soft tissue management. The choice of surgical approach depends on fracture severity, complexity, patient comorbidities, and surgeon preference and experience. In large skull defects, titanium mesh reconstruction offers good alternative to other biomaterials by eliminating the time consuming task of contour moulding. The aim of the study is to provide a comprehensive review of aesthetic and functional outcomes, involving titanium mesh implants associated with native bone reconstruction of frontal area posttraumatic defects. Also, the article is related to the authors own experience, in treating several patients with posttraumatic deformity of the frontal bone, assessing forehead contour aesthetics, pain, nerve function and late cerebral complications. A retrospective study was conducted using records from 14 adult patients, between 21-74 years of age, who underwent reconstruction of depressed frontal bone fractures, by receiving titanium mesh implants, between February 2013- October 2015. All patients had a minimum follow up of 5 months by clinical examination and periodic CT-scans. In order to evaluate the experimental results we follow different clinical parameters than late complications, like facial nerve function, cosmetic outcome, and pain. According our clinical results, titanium mesh is an effective method of forehead reconstruction, which provides predictably good long term results.