Reply to “Essentials of Cheek and Midface Implants”

Abstract

I read with great interest the article by Niamtu 1 Niamtu III, J. Essentials of cheek and midface implants. J Oral Maxillofac Surg. 2010; 68: 1420 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar entitled “Essentials of cheek and midface implants,” which reported on his personal experience in treating aging midface deficiency with facial implants. As for the vast majority of surgeons, the author also prefers preformed and non–custom-made implants, among which the porous polyethylene and silicone rubber undeniably get the lion's share. Although the author gives an exhaustive list of the common material for facial implant, for the sake of accuracy, I would like to discuss another material, polyetheretherketone (PEEK). PEEK is a semicrystalline thermoplastic polymer characterized by excellent mechanical and chemical properties, as well as biological safety, which makes this material a reliable alternative to the other alloplastic bone substitutes. At the beginning, PEEK polymers were especially used in spine surgery (interbody fusion cage implants) and in orthopedic surgery (hip implants). A great advantage with this material is that it can be coupled with the computer-aided design/computer-aided manufacturing techniques, thus allowing the manufacturing of custom-made implants, which can be exactly tailored according to the individual anatomy. Moreover, this procedure dramatically minimizes the need for major intraoperative manipulations, which are often necessary to adequately fit the non–custom-made implants, thus reducing the operative time. In 2007 we first reported on the use of a custom-made PEEK implant for the reconstruction of a large complex orbito-fronto-temporal defect. 2 Scolozzi P. Martinez A. Jaques B. Complex orbito-fronto-temporal reconstruction using computer-designed PEEK implant. J Craniofac Surg. 2007; 18: 224 Crossref PubMed Scopus (92) Google Scholar Since then, computer-designed PEEK implants have progressively gained in popularity, rapidly becoming a standard in calvarial reconstructive surgery. Conversely, the utilization of such implants for correcting facial problems has been and still is more problematic, essentially because of the technical difficulty in precisely reproducing the tortuous 3-dimensional anatomy of the facial skeleton. However, this procedure is particularly attractive for unilateral secondary post-traumatic or congenital maxillofacial deformities. In fact, in these cases the healthy side can be used as a template and computationally superimposed on the affected side using specific “mirroring” software. This allows for the creation of a patient-specific implant (PSI), which has the potential of precisely restoring the facial symmetry. So far, Kim et al 3 Kim M.M. Boahene K.D. Byrne P.J. Use of customized polyetheretherketone (PEEK) implants in the reconstruction of complex maxillofacial defects. Arch Facial Plast Surg. 2009; 11: 53 PubMed Google Scholar have been the only authors to report on unilateral midface rehabilitation (2 patients) using a computer-designed PEEK-PSI. Since the introduction of this technique in our department 3 years ago, 3 patients with residual maxillofacial defects (1 with secondary right post–orbito-zygomatic fracture deformity, 1 with mandibular asymmetry after bilateral sagittal split osteotomy, and 1 with chin deformity after advancement genioplasty) were treated by use of computer-designed PEEK-PSI at the Hôpitaux Universitaires de Genève in Switzerland. All the patients had a satisfactory and anatomically correct reconstruction of the maxillofacial defect as assessed on the immediate postoperative computed tomography scan. None of the patients had intraoperative or postoperative complications. In 1 patient 2 implants could not be placed given their limited size, which prevented their adequate stabilization. Essentials of Cheek and Midface ImplantsJournal of Oral and Maxillofacial SurgeryVol. 68Issue 6PreviewThis author has placed cheek implants sporadically for the past 25 years. Previous to 2004, expanded polytetrafluoroethylene cheek implants were used, but since that time, only Silastic implants (ImplanTech, Ventura, CA) have been placed. Full-Text PDF Letter to the EditorJournal of Oral and Maxillofacial SurgeryVol. 69Issue 4PreviewOne of the rewards of contributing to the scientific literature is the input of the readers. I thank Dr Scolozzi for his discussion of the use of polyetheretherketone (PEEK) in facial implant surgery. Although I am not aware of this material's availability in the United States for facial implants, I am aware of its use in orthopedics and other surgical specialties. It is important that our journal brings to the forefront new materials regardless of geographic acceptance. Dr Scolozzi reports on the use of PEEK for reconstructive cases, but my article was solely aimed at the use of silicone implants for cosmetic enhancement. Full-Text PDF