Abstract
Cranioplasty of the frontotemporoparietal region is particularly challenging given the thin skin and musculature in this area, predisposing one to an increased risk of contour deformity and cosmetic dissatisfaction following surgery. Herein, we describe a 36-year-old male who initially presented with a gunshot wound (GSW) to the head and a right parietal skull fracture and underwent a revision of his cranioplasty procedure due to significant temporalis muscle atrophy, resulting in a sunken appearance of the right temporalis fossa following a craniectomy and multiple surgeries for hematoma evacuation. The patient underwent cranioplasty for definitive repair of his defect, and at follow-up, significant temporalis muscle atrophy resulted in a sunken appearance of the right temporalis fossa. A calcium phosphate bone substitute was used to fill the deformity, but dissolution and migration of the cement at follow-up necessitated a repeat cranioplasty procedure. Alloderm™ (Allergan Corp., Dublin, Ireland), an acellular dermal matrix derived from cadaveric skin, which has been previously used for dural repair, was successfully used in this study as a buffer between the skin and a cranioplasty implant to enhance cosmetic outcomes in a revision cranioplasty procedure following temporalis muscle atrophy.
Highlights
Prosthetic materials utilized in cranioplasty commonly fall into one of three categories: metallic, ceramic, or polymer-based [1]
AllodermTM (Allergan Corp., Dublin, Ireland), an acellular dermal matrix derived from cadaveric skin, which has been previously used for dural repair, was successfully used in this study as a buffer between the skin and a cranioplasty implant to enhance cosmetic outcomes in a revision cranioplasty procedure following temporalis muscle atrophy
While computer-aided implant designs provide a precise fit for cranial deficits, they do not address the issue of soft tissue coverage or muscular atrophy, the frequent factors associated with traumatic head injury repair [3]
Summary
Prosthetic materials utilized in cranioplasty commonly fall into one of three categories: metallic, ceramic, or polymer-based [1]. A large subgaleal fluid collection was noted Several months after this hospital stay, the patient underwent cranioplasty for definitive repair of his cranial defect using a customfitted 3D PEEK implant (Stryker Corp., Kalamazoo, Michigan; Figure 2). The cranioplasty with PEEK implant achieved excellent cranial contour, at follow-up, the patient was noted to have a significant “hollowing out” and sunken appearance of the right temporalis fossa due to significant temporalis muscle atrophy. Cranioplasty augmentation was performed to address this deficit During this initial reconstruction, the temporalis muscle was mobilized, and a calcium phosphate bone substitute was used to fill the space just rostral to the zygoma and posterior to the right orbit. A small bump above the zygoma was present, indicating slight migration of the layered AllodermTM inferiorly
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