Calcium Hydroxylapatite Gel Research Articles

Alterations in Nasal Sensibility Following Calcium Hydroxyapatite Dorsal Augmentation.

There are a many types of filler products that surgeons used for soft tissue augmentation. Soft Tissue Fillers, also known as injectable grafts, is a medical device implants. One of the materials used in soft tissue fillers is calcium hydroxylapatite (CaHA) that is commonly used for treating nasal deformities and nasal reshaping too. Calcium hydroxylapatite is a kind of mineral that can be found in human teeth and bones. It is considered long-lasting but nonpermanent filler and is biocompatible with human tissue. The aim of this study is to measure the alterations in sensibility and patient satisfaction following CaHA filler injection. In a prospective study, 30 patients who underwent CaHA filler injections from January to December 2016 at a Private Tertiary Care Hospital in Riyadh, Saudi Arabia were included. Means and standard deviations were measured for pressure threshold values at each test area preprocedure 2 weeks after procedure (). Alterations between pre and postprocedure values were verified using the match-paired Student t test preprocedures. None of the patients had any subjective sensory symptoms. Majority of patients were extremely satisfied with the results.(Table is included in full-text article.) CONCLUSION:: With correct anatomic knowledge and precise technique in doing the CaHA gel injection procedure, nasal sensibility will not be altered. In addition, injection of CaHA gel can be valuable tool for plastic surgeons to consider for nasal reshaping.

Anterior Filler Displacement Following Injection of Calcium Hydroxylapatite Gel (Radiesse) for Anophthalmic Orbital Volume Augmentation

To describe the complication of anterior filler displacement following injection of calcium hydroxylapatite gel (Radiesse) for anophthalmic enophthalmos correction. Retrospective case series of patients who experienced anterior filler displacement following orbital injection of calcium hydroxylapatite. Data includes patient demographics, indication for injection, route and volume of injection, description of postinjection complications, and final outcome. Four cases of anterior filler displacement and expansion following injection of calcium hydroxylapatite were identified. The patients' ages ranged from 33 to 64 years old. All 4 patients underwent multiple prior orbital surgeries and suffered from anophthalmic enophthalmos. Injectable calcium hydroxylapatite was delivered transcutaneously, to the deep extraconal orbital space, via 27-gauge, 1.25-inch retrobulbar needles. Each patient received an initial 1.3 ml of filler, with 1 patient receiving an additional 0.8 ml. Within 1 week, all patients experienced prominent, edematous lower eyelids. A CT scan of 1 patient radiographically documented anterior migration of the filler material. Two patients required transconjunctival excision of the filler and infiltrated orbital fat. Histopathologic examination of 1 specimen revealed chronic foreign body granulomatous inflammation. Two patients were treated medically, with resolution of clinical findings over 6 to 9 months. Anterior filler displacement is a potential complication of orbital volume augmentation with injectable calcium hydroxylapatite. Patients should be counseled regarding this possibility when considering options for the treatment of anophthalmic enophthalmos. A history of multiple prior orbital surgeries, with associated tissue disruption and scarring, may be a risk factor for filler displacement.

Soft Tissue Fillers in the Nose

Using soft tissue fillers to correct postrhinoplasty deformities in the nose is appealing. Fillers are minimally invasive and can potentially help patients who are concerned with the financial expense, anesthetic risk, or downtime generally associated with a surgical intervention. A variety of filler materials are currently available and have been used for facial soft tissue augmentation. Of these, hyaluronic acid (HA) derivatives, calcium hydroxylapatite gel (CaHA), and silicone have most frequently been used for treating nasal deformities. While effective, silicone is known to cause severe granulomatous reactions in some patients and should be avoided. HA and CaHA are likely safer, but still may occasionally lead to complications such as infection, thinning of the skin envelope, and necrosis. Nasal injection technique must include sub-SMAS placement to eliminate visible or palpable nodularity. Restricting the use of fillers to the nasal dorsum and sidewalls minimizes complications because more adverse events occur after injections to the nasal tip and alae. We believe that HA and CaHA are acceptable for the treatment of postrhinoplasty deformities in carefully selected patients; however, patients who are treated must be followed closely for complications. The use of any soft tissue filler in the nose should always be approached with great caution and with a thorough consideration of a patient's individual circumstances.

A Complication of Injection Laryngoplasty Using Radiesse

CASE A 50-year-old male presented to a community-based otolaryngologist with a four year history of hoarseness. Fiberoptic laryngoscopy revealed mild, bilateral atrophy of the true vocal folds with incomplete closure. The patient underwent bilateral true vocal fold injection laryngoplasty with Radiesse. He continued to have a breathy voice postoperatively. Three months after the first injection, bilateral injection laryngoplasty with Radiesse was repeated. Following this operation, the patient's voice became significantly worse. He presented to our center where videostroboscopy revealed significant loss of mucosal wave. There was evidence of calcium hydroxylapatite bilaterally within the superficial lamina propria of the true vocal folds. We cared for this patient conservatively using a combination of medical management, voice therapy and serial videostroboscopy. His voice improved and videostroboscopy confirmed partial resorption of Radiesse. The patient’s voice has returned to eighty percent of baseline. REFERENCES 1. Rosen CA, Gartner-Schmidt J, et al. Vocal fold augmentation with calcium hydroxylapatite (CaHA). Otolaryngol Head Neck Surg 2007;136,198-204. 2. Rosen CA, Thekdi AA. Vocal fold augmentation with injectable calcium hydroxylapatite: Short-term results. J Voice 2004;18:387-391. 3. Hughes RGM, Morrison M. Vocal cord medialization by transcutaneous injection of calcium hydroxylapatite. J Voice 2004; 19:674-678. 4. Belafsky PC, Postma GN. Vocal fold augmentation with calcium hydroxylapatite. Otolaryngol Head Neck Surg 2004;131:351-4. 5. Chheda NN, Rosen CA, et al. Revision laryngeal surgery for the suboptimal injection of calcium hydroxylapatite. Laryngoscope, 2008;118:22602263. 6. Chhetri DK, Jahn-Parwar B, et al. Injection laryngoplasty with calcium hydroxylapatite gel implant in an in vivo canine model. Ann Otol Rhinol Laryngol 2004;113:259-264. CONCLUSIONS This case illustrates that subepithelial injection of Radiesse can be treated conservatively. There is at least partial resorption of Radiesse which is documented photographically in this report. However, given the evidence in prior studies regarding calcium hydroxylapatite's long term stability, complete resorption of Radiesse would not be expected.6 BACKGROUND In the treatment of unilateral impairment of vocal fold motion and glottic insufficiency, an injectable form of calcium hydroxylapatite (Radiesse) has shown some promise in true vocal fold augmentation secondary to its inert properties and relative long-term stability.1-4 In preliminary case series, few complications have been reported. Subepithelial injection with poor voice outcome has been reported and managed most often with surgical excision after observation for a period of months.3,5 We present a complication of bilateral subepithelial injection with Radiesse that we managed without surgery. Photodocumentation of this case shows partial resorption of the implant and the patient’s voice improved significantly.

Calcium Hydroxylapatite Gel (Radiesse) Injection for the Correction of Postrhinoplasty Contour Deficiencies and Asymmetries

To describe our technique for the injection of calcium hydroxylapatite gel (Radiesse) to treat postrhinoplasty contour defects and to evaluate the agent's efficacy, duration of action, required dosage, complication rates, and patient satisfaction. Slight defects or asymmetries are not uncommon, even after well-executed rhinoplasty surgery in the most expert of hands. These contour deformities have been treated with filler agents in the past, but with mixed results. Calcium hydroxylapatite gel was recently introduced as a filler agent in facial plastic surgery, but its use has not yet been described in the correction of postrhinoplasty nasal contour defects. A prospective before-and-after trial conducted in a private-practice facial cosmetic surgery office. Eligible patients had postrhinoplasty contour irregularities or asymmetry. Postrhinoplasty irregularities at the nasal dorsum or tip underwent subcutaneous injection with calcium hydroxylapatite. Main outcome measures included number of treatments, posttreatment injection pain score, required dose and complications, natural feel, patient satisfaction, and length of follow-up. Digital photographs were evaluated by blinded observers. Thirteen patients were followed up prospectively for a mean of 2.5 months. The mean injection pain score was 1.9 (scale, 0-5); the mean dose, 0.19 mL. Patient satisfaction was good to excellent in 11 (85%) of 13 cases. Photographic improvement was seen in 15 (88%) of 17 treatment sites. Calcium hydroxylapatite gel has been shown in this study to improve postrhinoplasty nasal symmetry and smooth the curves and lines that constitute the contour of the nose. The longevity of nasal augmentation by calcium hydroxylapatite remains unsettled; long-term safety is also unknown. Long-term studies of safety and efficacy are indicated.

Injection Laryngoplasty with Calcium Hydroxylapatite Gel Implant in an in Vivo Canine Model

The ideal injectable agent for vocal fold medialization is biocompatible, durable, sized to prevent phagocytosis and migration, and formulated for easy injection and does not adversely affect the viscoelastic properties of the vocal fold. We tested a cohesive implant of calcium hydroxylapatite (CaHA) particles in a gel carrier in an in vivo canine model of phonation. Six dogs underwent unilateral recurrent laryngeal nerve section and injection laryngoplasty of the paralyzed vocal fold with a CaHA implant. The six follow-up examinations were performed at 1, 2, 3, 6, 9, and 12 months, and the larynx and bilateral neck lymphatic system were harvested for histologic analysis. The CaHA implant adequately medialized the vocal fold to regain glottal closure. The mucosal waves remained unaltered from baseline. The implant remained soft in the larynx and did not migrate to the neck lymphatic system. A localized foreign body giant cell reaction was present on histologic evaluation, but not acute or other chronic inflammation. A size analysis revealed no resorption of the CaHA particles. A decrease in medialization was noted at all follow-up intervals related to resorption of the aqueous-based gel carrier. The CaHA implant appears to be relatively safe and suitable for injection laryngoplasty.