Major Complication in Methyl Methacrylate Cranioplasty-A Case Report

Abstract

The main purposes of reconstruction of cranium are the protection of the brain from injury and to restore better aesthetic contour. Methyl methacrylate is the most commonly used alloplastic material in cranioplasty. Especially in large cranial defect, it offers the craniofacial surgeons an alternative in cranioplasty when autogenous bone graft is not indicated or not sought by the patient. However its complications such as infection, loosening and extrusion do occur. We present a case of frontal cranioplasty using methyl methacrylate cement with major complication. The complication developed 5 months after methyl methacrylate cranioplasty; forehead overlying skin necrosis and exposure of methyl methacrylate cement was noted. We managed the case with removal the cement, reconstruction of frontal bone with autogenous split-thickness calvarial bone graft, and free radial forearm flap coverage. The aesthetic result was poor. Scarring skin and soft tissue replacement before cranioplasty either with tissue expander or free skin flap transfer may prevent the patient from this major complication.