Porous High-density Polyethylene Research Articles

Extrusion of High-density Porous Polyethylene Implants in the Nose.

Few alloplastic implant materials have been successfully used in nasal reconstruction. The high-density porous polyethylene (HDPE) implant is the most widely accepted alloplastic material for reconstructing the nasal structure. Some authors suggest that the problems associated with using grafts and biocompatible materials are often due to errors on the part of the surgeon or the technique used. This study aims to report several cases of complications related to using HDPEs in the nose. A total of 23 patients who reacted negatively to alloplastic implants were treated. The removal of HDPE is complex due to the formation of connective tissue within it. These complications can cause permanent atrophic changes to the skin of the nose. Most of the patients presented with extrusion of their HDPE implants in the nasal columella region. All patients underwent implant removal, cleaning, disinfection, and secondary rhinoplasty. Surgeons must be able to recognize these possible complications and manage them successfully. Even today, many professionals use alloplastic grafts for reconstruction and esthetics of the nasal region. The potential for permanent damage to the skin and soft tissues, as well as complications such as infection and extrusion of the implant, makes the use of autogenous tissue preferable over alloplastic implants. Early detection and immediate treatment of complications are essential to minimize the severity of the deformity.

Short-Term Outcomes of High-Density Porous Polyethylene Orthoses for Chin and Gonial Angle Augmentation.

This retrospective observational study evaluated 100 patients over 18years. Data on age, sex, aesthetic complaints, surgery types, and postoperative complications were collected and analyzed using the two-proportion z-test and descriptive statistics in RStudio 4.3.3. All patients with neuropraxia underwent neurosensory evaluation. The average age was 35.92years for males and 33.71years for females, with a male predominance (76%). Aesthetic complaints were prevalent in 72% of patients (p < 0.01). Chin surgery was performed on 56% of patients, jaw angle surgery on 17%, and both on 39%. Complications included one case of suture dehiscence, three wound infections, and four transient cases of paresthesia, all resolving within 30days. Overall, patient satisfaction with outcomes was high. High-density porous polyethylene implants proved effective and safe in enhancing facial aesthetics and correcting mandibular deformities. Further research should focus on long-term outcomes to consolidate these findings. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Long-Term Mental Health after High-Density Polyethylene-Based Porous Orbital Implant in Enucleated and Eviscerated Patients

Objectives: To assess the overall mental health of enucleated or eviscerated patients after high-density porous polyethylene OCULFIT implantation and external prosthesis over a 1-year follow-up. Methods: Patients with an indication of enucleation or evisceration with OCULFIT implantation were included in a prospective study. The patients completed four questionnaires regarding mental health at three different visits (baseline, 3–6 months, and 9–12 months post-surgery). The questionnaires used were the following: SF-12 for multidimensional health-related quality of life (scale 0–100); Rosemberg self-esteem scale (scale 0–40); Patients Health Questionnaire-4 (PHQ-4) (scale 0–6); and a Lifetime Major Depression and Anhedonia questionnaire (categorised in groups with/without symptoms). Results: A total of 33 patients (16 enucleations and 17 eviscerations) were included in the study. The physical domain of the SF-12 questionnaire did not change between visits, but the mental domain significantly improved from the baseline to the last visit (41.71 ± 12.72 vs. 46.80 ± 10.68, p = 0.04). The number of patients with high, moderate, and low self-esteem (Rosemberg scale) was similar between the baseline and the last visit. The depression and anxiety scores of the PHQ-4 were not significantly different among visits. The number of patients with no symptoms (depression or anhedonia) improved from the baseline (42.2%) throughout the follow-up (66.7% at the last visit). Conclusions: OCULFIT orbital implant and external prosthesis placement maintained and/or improved the quality of life related to mental health in eviscerated and enucleated eyes. The number of patients with no symptoms improved from the baseline throughout the follow-up. The patients’ self-esteem was already high before implantation and remained stable over the follow-up.

Application of Submucosal Trans-Septal Suturing Technique in a Septal Extension Graft With Porous High-Density Polyethylene and Concurrent Nasal Lateral Osteotomy.

Recently, a submucosal trans-septal suturing (STSS) technique was introduced to obviate the dead space of septum after septal extension graft (SEG) with porous high-density polyethylene (pHDPE). To investigate STSS technique after SEG with pHDPE and concurrent nasal lateral osteotomy (LO). A retrospective study was conducted in 53 patients who underwent a STSS technique after SEG with pHDPE and concurrent LO. The postoperative discomfort (nasal pain and obstruction), the width of the nasal bony base, Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcomes Evaluation (ROE), and complications were recorded and assessed. The mean surgical duration of STSS was 862.53±227.73 seconds. The maximal mean score of postoperative nasal pain and nasal obstruction was 2.132±0.921 and 1.868±0.8995, respectively. The values on the width of the nasal bony base and ROE were significantly improved after surgery. There was no significant difference in NOSE values preoperatively versus 6 months postoperatively. An infection was found in 1 patient, a recurrent minor bleeding of septum in another patient, and a symptomatic nasal obstruction in other 2 patients. There was no major bleeding, hematoma, foreign body sensation, septal perforation, and other infection. STSS can eliminate the postoperative dead space of nasal septum with low discomfort and complications, and help to avoid a lateral displacement of osteotomized nasal bony segment (ONBS) in patients undergoing SEG with pHDPE and concurrent LO.

Submucosal Trans-Septal Suturing Technique After a Septal Extension Graft with Porous High-Density Polyethylene: A Technical Report.

Porous high-density polyethylene (pHDPE) is an alternative material for a septal extension graft (SEG) in oriental rhinoplasty when autologous cartilage is limited. Although nasal packing (NP) and trans-septal suturing (TSS) techniques are routine procedures to obviate the dead space after septoplasty, they are associated with certain discomforts and complications. To investigate the application of a submucosal trans-septal suturing (STSS) technique after SEG with pHDPE. A prospective study was conducted on 60 female participants who underwent SEG with pHDPE. The participants were randomly divided into the NP group and STSS group. The extra surgical duration of NP and STSS, pain, nasal obstruction, and sleeping disturbance as well as postoperative complications were recorded and compared between groups. No significant difference was found between group NP and group STSS in terms of mean age. The mean extra surgical duration of group STSS was significantly longer than group NP. There were significant higher pains of group NP at 24 hours and 48 hours postoperatively, compared with group STSS. The NP group also experienced significantly more nasal obstruction and sleep disturbance within 48h postoperatively compared to the STSS group. There was one infection in each group, minor bleeding in two NP patients, and one STSS patient. There was no major bleeding, hematoma, graft exposure, or septal perforation in both groups. Although STSS needs a longer extra surgical duration than NP, it significantly improves the patient's postoperative comfort with a faster return to normal respiration compared to NP. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

CURRENT APPROACHES TO MANAGING MICROTIA

Microtia, a developmental anomaly of the external ear resulting in a deformed auricle, affects 1 to 5 individuals per 10,000. Literature suggests a male predominance, with nearly 2.5 times more male patients affected than females. Additionally, there is a notable right-sided predilection, leading to pronounced asymmetry, observed in approximately 83% of cases. Surgical reconstruction is the primary treatment for microtia, albeit a technically demanding procedure with challenges in achieving optimal aesthetic outcomes. Reconstruction typically involves autologous costal cartilage, known for its effectiveness but requiring advanced surgical skills. Complications, including pneumothorax, postoperative pain, chest wall deformity, and pathological scarring, are common with this approach. In recent years, surgeons have increasingly adopted modern techniques utilizing porous high-density polyethylene implants for reconstruction. This approach is gaining popularity due to the challenges associated with achieving satisfactory cosmetic results using autologous costal cartilage reconstruction. Based on the bibliosemantic and analytical methods employed to analyze the literature, we posit that this topic necessitates further investigation and a multidisciplinary approach. The involvement of otolaryngologists and maxillofacial surgeons is imperative for the comprehensive treatment of this pathology.

HIGH DENSITY POROUS POLYETHYLENE FACIAL IMPLANTS AS AN ALTERNATIVE MATERIAL IN MAXILLOFACIAL RECONSTRUCTION - AN INTEGRATIVE REVIEW

Porous high-density polyethylene (PPAD) is a material used for around 30 years in superficial reconstruction surgeries, a fact demonstrated in several cases in clinical practice. However, some questions arise regarding its safety, frequency and differences with other materials. Therefore, an integrative review of the literature was carried out using 9 articles found and selected in the Pubmed and Medline databases with the aim of analyzing their properties as a material of choice in maxillofacial reconstruction surgeries, clarifying the principles of biocompatibility, durability and safety., as well as its complications and failure rates. In terms of safety, PPAD was a reported material, with a low risk of complications, with infection being the main one. However, the authors cite some conditions that influence infection rates. Furthermore, it is characterized to present several advantages in relation to other materials used as metallic implants, such as PMMA, silicone, ePTFE, PEEK, and metallic implants. Therefore, polyethylene provides a permanent result, with good facial contouring, cost-benefit and long-term safety for the patient.

HIGH DENSITY POROUS POLYETHYLENE FACIAL IMPLANTS (PPAD) IN OROFACIAL HARMONIZATION

This work constitutes a literature review that explores the significance of Orofacial Harmonization Procedures (OHP) utilizing High-Density Porous Polyethylene Facial Implants (HDPE) to enhance facial aesthetics, contouring, rejuvenation, and volume augmentation. The paper addresses both theoretical and practical aspects of these procedures, providing insights into surgical technique, anatomy of treated areas, pre-operative assessment, anesthesia, pharmacology, medication, post-operative care, and potential complications. The review underscores the role of facial aesthetics in forming initial impressions and how aesthetic dental procedures within OHP are gaining popularity to achieve such harmony. It also emphasizes the integration of positive psychology in understanding aesthetic procedures, considering the positive psychological impacts on patients’ self-esteem and confidence. The work comprehensively discusses the use of HDPE as an alloplastic material for facial implants, elucidating its attributes such as the porous structure enabling implant vascularization and incorporation, along with its superiority over other materials in terms of inflammation and durability. Practical aspects of performing these procedures are addressed, encompassing commonly treated areas (chin, jaw, cheek), incision and suture techniques, anesthesia selection, antibiotic administration, and pre- and post-operative care. Furthermore, potential complications are presented, including improper patient selection, edema, infection, migration, extrusion, and others. The study highlights the significance of proper patient selection, surgical technique, and post-operative care for successful HDPE facial implant procedures. The review concludes that this technique can yield significant benefits in enhancing patients’ self-esteem and appearance, yet underscores the importance of adequate professional training and rigorous monitoring to prevent complications.

Application of a Single T-Shaped Porous High-Density Polyethylene in Oriental Nasal Tip-Plasty.

Porous high-density polyethylene (pHDPE) is an alternative material for septal extension grafts. This study investigated the clinical application of a single T-shaped pHDPE graft combined with auricular cartilage in oriental nasal tip-plasty. A retrospective analysis was conducted of 66 patients who underwent septal extension graft with a T-shaped pHDPE and auricular cartilage graft from December 2018 to November 2021. All patients were female from 19 to 51 years old (average: 28.9 years). Patients were followed up for 5 to 40 months with an average of 23.8 months. The postoperative nasal length (39.8±3.7mm) was significantly improved (35.6±5.7mm preoperatively, P <0.0001) with the tip projection increasing from 23.9±2.3mm preoperatively to 25.3±2.4mm postoperatively ( P =0.0005). There was a significant difference in the nasolabial angle (96.8±14.1 degrees preoperatively versus 101.8±7.2 degrees postoperatively, P =0.0105) but no significant change in the nasofrontal angle (143.3±9.5 degrees preoperatively versus 143.7±5.5 degrees postoperatively, P =0.7546), with an improved tip projection achieved in 93.9% of patients. One patient had an abscess in the nasal septum and a tip graft was performed using auricular cartilage in another patient because of an insufficient postoperative tip projection. There was a slight tip deviation in 2 patients, 1 case of a deviated nasal tip was corrected with a pHDPE sheet graft, while the other was left intact. Two patients had excess cartilaginous graft protruding to the nasal cavity that did not affect nasal ventilation and the shape of the nasal tip was relatively good, so the prominent cartilaginous graft was not addressed. In conclusion, this technique not only improved the bulbous nasal tip, lengthened the short nose, and increase the tip projection, but also prevented absorption of the existing septal cartilage and reduced infection or extrusion of the pHDPE.

Complications Following Alloplastic Chin Augmentation: A Systematic Review of Implant Materials and Surgical Techniques.

Alloplastic implantation has become a popular method of chin augmentation. Historically, silicone was the most commonly used implant, but porous materials have grown in favor due to improved fibrovascularization and stability. Nevertheless, it is unclear which implant type has the most favorable complication profile. This systematic review aims to compare the complications of published chin implants and surgical approaches to provide data-driven recommendations for optimizing chin augmentation outcomes. The PubMed® database was queried on March 14, 2021. We selected studies reporting data on alloplastic chin augmentation excluding additional procedures such as osseous genioplasty, fat grafting, autologous grafting, and fillers. The following complications were extracted from each article: malposition, infection, extrusion, revision, removal, paresthesias, and asymmetry. Among the 39 articles analyzed, the year of publication ranged from 1982 to 2020; additionally, 31 were retrospective case series, 5 were retrospective cohort or comparative studies, 2 were case reports, and 1 was a prospective case series. More than 3104 patients were included. Among the 11 implants reported, the 3 implants with the highest number of publications were silicone, high-density porous polyethylene (HDPE), and expanded polytetrafluoroethylene (ePTFE). Silicone demonstrated the lowest rates of paresthesias (0.4%) compared to HDPE (20.1%, P < 0.01) and ePTFE (3.2%, P < 0.05). In contrast, there were no statistically significant differences in rates of implant malposition, infection, extrusion, revision, removal, or asymmetry when stratified by implant type. Various surgical approaches were also documented. Compared with subperiosteal implant placement, the dual-plane technique demonstrated higher rates of implant malposition (2.8% vs 0.5%, P < 0.04), revision (4.7% vs 1.0%, P < 0.001), and removal (4.7% vs 1.1%, P < 0.01), but a lower incidence of paresthesias (1.9% vs. 10.8%, P < 0.01). Compared with extraoral incisions, intraoral incisions resulted in higher rates of implant removal (1.5% vs 0.5%, P < 0.05) but lower rates of asymmetry (0.7% vs 7.5%, P < 0.01). Silicone, HDPE, and ePTFE had low overall complication rates, demonstrating an acceptable safety profile regardless of implant selection. Surgical approach was found to significantly influence complications. Additional comparative studies on surgical approach while controlling for implant type would be beneficial for optimizing alloplastic chin augmentation practices.

Repair of exposure and fracture of the porous high-density polyethylene framework after ear reconstruction

ObjectiveTo assess the repair method of exposure or fracture of the porous high-density polyethylene ear framework after total auricle reconstruction.Study designA prospective case study.MethodsFrom April 2018 to October 2021, 11 patients with framework exposure or fracture after total auricle reconstruction were admitted to the hospital for repair. In these 11 patients, the repair was performed using (1) a temporal muscle flap combined with free skin graft in 5 patients, (2) a mastoid fascia flap combined with free skin graft in 2 patients, (3) a simple local skin flap in 1 patient, (4) combination of a temporalis muscle flap and a mastoid fascia flap together with free skin graft in 2 patients, and (5) a Su-Por helix material combined with a temporal muscle flap and free skin graft in 1 patient.ResultsAfter follow-up for 3–36 months, except for one patient in whom local exposure again occurred at the same site, the framework was in a good shape in the other patients, and all the skin graft survived.ConclusionThe defect of the upper part of the auricle can be repaired using a temporal muscle flap combined with temporal muscle fascia and skin graft. The defect of the middle and lower part of the auricle can be repaired using a mastoid fascia flap combined with skin graft. For framework fracture, the damaged site can be first strengthened with another ear material and then combined with the adjacent fascia flap and free skin graft.

Commentary on “Complications Associated with Use of Porous High-Density Polyethylene in Rhinoplasty” by Davis et al

Commentary on “Complications Associated with Use of Porous High-Density Polyethylene in Rhinoplasty” by Davis et al

Complications Associated with Use of Porous High-Density Polyethylene in Rhinoplasty.

Background: Porous high-density polyethylene (pHDPE) has successfully been used as an alternative to cartilage for grafting in rhinoplasty; however, concerns exist surrounding its potential for infection and/or extrusion. Objectives: To analyze the relationship between complication rates associated with pHDPE in rhinoplasty and graft location relative to shear force applied by external manipulation. Methods: Retrospective review of 116 patients undergoing pHDPE rhinoplasty for 10 years. Results: Minor postoperative complications occurred in 3.4% of patients, each resolving with conservative management. Major complications including infection or extrusion occurred in 5.2% of all patients, at an average of 36.9 months postoperatively. All major complications occurred in patients with grafts extending into the caudal nose, and two-thirds ultimately necessitated surgical intervention. Conclusions: Cephalically contained pHDPE grafts are less prone to failure than those extending into the caudal nose. Long-term follow-up is recommended for all patients based on the risk for delayed complications.

Revision Operation of the Unsatisfactory Microtia Reconstruction With Autologous Costal Cartilage.

Revision operation of the unsatisfactory microtia reconstruction is 1 of the most difficult revision operations in plastic surgery. This study discussed the cases about revision operation of the unsatisfactory or failed ear reconstruction using autologous costal cartilage and residual. A prospectively maintained database of all consecutive patients who underwent secondary total ear reconstruction from 2013 to 2020 was reviewed. Demographic data and outcomes were assessed. Thirty-six patients with microtia met the inclusion criteria. The age of the patients who underwent secondary reconstruction ranged 6 to 56 years. The follow-up duration was from 1 to 8 years. Primary reconstruction using costal cartilage was performed in 34 cases, and Medpor (porous high-density polyethylene) were used in 2 cases. All 36 cases were treated with costal cartilage as the revision. One-stage revision was performed in 27 cases, including scaffold covered by superficial temporal fascia flap in 9 cases, retroauricular fascia flap in 12 cases and superficial temporal plus retroauricular fascia flap in 5 cases. Nine cases were renovated with expanders by stages, of which 8 cases were covered by retroauricular fascia and 1 case was covered by expanded skin flap. Complications occurred in 2 cases, and 1 patient was not satisfied with the partial scaffold repair. The effect of revision operation of ear reconstruction with costal cartilage is satisfactory, and different methods of ear reconstruction are indicated in different operation conditions, and the revision surgery requires adequate preoperative evaluation.Level of Evidence: Level IV, therapeutic study.

Novel method for high-density porous polyethylene ear reconstruction stent remodeling to achieve high satisfactory outcomes.

We aimed to explore a novel method for ear reconstruction stent remodeling to achieve high patient satisfactory outcomes. This study is a retrospective review of patients with congenital or acquired ear defects who were prepared for one-stage ear reconstruction with high-density porous polyethylene stent between May 2020 and May 2021. A standardized data collection template was used to collect related variables. In this study, the detailed reconstruction surgery process is carefully described, and the postoperative healing process of the ear reconstruction was closely observed. A total of 26 patients for one-stage ear reconstruction with high-density porous polyethylene stent or autogenous costal cartilage scaffolds were admitted to the department of plastic surgery in our hospital between May 2020 and May 2021. All patients were followed until their ear flaps were alive and details of the ear shape were revealed. The patients with new remolding method were no severe complications and only a patient had stent exposure, and were highly satisfied with both appearance and function. The application of novel remodeling method is a promising way for ear reconstruction stent shaping with little postoperative complication and excellent postoperative patient satisfaction.

Patient specific implants in orbital reconstruction: A pilot study

PurposeSuccessful repair of the orbital skeleton restores function and cosmesis by normalizing globe position and allowing full motility of the extraocular muscles. Routine repairs are successful with standard implants. However, defects that are irregular or cause volume deficiency can be challenging to repair. The development of patient specific implants (PSI) offers an additional tool in complex cases. Herein, we report our experience using PSI for orbital reconstruction. MethodsAn IRB-approved review was conducted of consecutive patients who received PSI from 8/2016–9/2018. Demographic and examination findings were recorded. PSI was designed using high-density porous polyethylene or polyetheretherketone (PEEK) and implanted for repair. The postoperative course was reviewed for outcomes and complications. ResultsEight patients were identified. Two had silent sinus syndrome, 3 were complex facial fracture revisions, and 3 were post-oncologic reconstruction. Seven received porous polyethylene implants, and 1 had a PEEK implant. Mean follow up time was 10.2 months (3.3–28.3). All had an improved functional and aesthetic result. Diplopia and enophthalmos completely resolved in 60% of fracture and silent sinus patients. All fracture and silent sinus patients were orthotropic without diplopia in primary gaze at last follow up. Tumor patients had improvement in symmetry and functionality. There were no complications. Conclusion and importanceComplex orbital skeleton derangements can be difficult to repair and standard implants may incompletely resolve the anatomic problem. In challenging cases, PSI may better achieve an aesthetically and anatomically successful outcome and improve functionality.

Systematic Review of Medpor Versus Autologous Ear Reconstruction.

Ear reconstruction is 1 of the most technically challenging sub-specialties of craniofacial and reconstructive plastic surgery. The reconstructive ear must not only fulfil the requirement of being aesthetically pleasing but must also have good vascularity with a low complication rate. Several ear reconstructive techniques have been developed such as the autologous ear reconstruction technique using costal cartilage and ear reconstruction with high-density porous polyethylene or Medpor (Porex Surgical, Inc, College Park, GA). Autologous ear reconstructive techniques have advantages of durability and low infection rates however are associated with poorer aesthetic outcomes such as poor projection of the ear. Medpor has advantages of a more consistent three-dimensional definition without the need to harvest costochondral cartilage and create a donor site. However, due to its alloplastic material properties, Medpor has historically been reported as having a higher rate of extrusion and infection. This is the first systematic review to compare the outcomes of both techniques. The 6 studies that were reviewed were analyzed against 3 evaluative criteria: aesthetic outcome, complication rate, and convenience of intervention. This is so a comprehensive, evidence-based decision can be made by the surgeon and patient when ear reconstruction is required. The results showed heterogeneity in data and a lack of detailed descriptions of the assessment for aesthetic outcomes and convenience, hence were inconclusive. The results however showed that there were more complications with Medpor framework with 15% of total cases resulting in either extrusion or infection compared to 2% of autologous ear reconstruction framework.

Clinical Study of Hydroxyapatite-Based Eye Socket Filler in Surgery

An irreversible injury of the eyeball requires patients to undergo enucleation or enucleation of the contents of the eyeball. Due to the absence of organs in the eye socket, its collapse, the drooping of the upper eyelid, and possibility of an eyeball excision syndrome make severe facial deformity frequently occurs. To analyze the effect of applying hydroxyapatite (HA) materials in an eye socket filling surgery, patients requiring the surgery were recruited in this study and divided into two groups according to different eye prostheses selected by patients. Nano-HA orbital implantation was selected in the HA group, and porous high-density polyethylene was selected in the PE group. The activity of the artificial eye platform and Visual Analogue Scale scores were significant difference in both groups. Nevertheless, in the HA group, the total complication rate was lower, and the postoperative facial satisfaction was higher, all P &lt; 0.05. Therefore, it is speculated that the use of nano-HA as an eye socket filling material in an eye socket filling surgery reduces postoperative complications, improves the appearance to a certain extent, and has clinical application value.

A Staged Approach for Contouring of Temporal Deformities Using Porous Polyethylene and Lipofilling.

Many studies evaluated the effectiveness of a single reconstructive material during temporal cranioplasty, or in comparison to the outcome of another material. To our knowledge, no previous study evaluated a staged combination of reconstruction modalities during temporal cranioplasty. In a prospective interventional study, the authors combined high-density porous polyethylene (HDPP) implant insertion (stage I) with a following lipofilling session (stage II) in 8 patients scheduled for temporal cranioplasties. This two-staged approach was evaluated 6 months after each stage independently. The patients' satisfaction as regards the aesthetic outcome was evaluated through a 5-points Likert scale by the patients themselves. For every individual patient, this psychometric analysis was repeated by medical staff from other departments. Statistical analysis of the patients and medical staff satisfaction scores showed a statistically significant increase after the addition of lipofilling session (stage II) if compared to implant insertion only (stage I). Clinically, this outcome was maintained in a long-term follow-up ranged from 1 - 8 years. Nevertheless, 2 patients needed one more lipofilling session to obtain their satisfaction as regards the final aesthetic outcome. No other complications were recorded in this study. In conclusion, combining alloplastic and autogenous reconstruction modalities in a staged approach can suffice the reconstruction requirements for such temporal defects. After a long follow-up period, the insertion of high-density porous polyethylene implant with the addition of a following lipofilling session showed more evaluators' satisfaction in terms of the final aesthetic outcome.

Juvenile Ossifying Fibroma: Multiportal Endoscopic Trans-Nasal and Orbital Surgical Approaches, Histopathological and Radiological Findings

Abstract: Ossifying fibroma of the nasal cavity and paranasal sinus is a benign tumor histologically, however clinically may show invasive characteristics. It has malignancy rate of 0.4–0.5%. Here, we presented a 2 rare cases of Ossifying fibroma in two female children with Juvenile ossifying fibroma of the paranasal sinuses with orbital involvement and reviewed the literature of this rare tumour. Both cases subjected to complete ENT and ophthalmological examination and investigated by CT study of the paranasal sinuses, orbit and brain using specific protocol. Both underwent excision of the lesions as much as accessible and applicable to avoid complications and morbidity through combined trans-nasal endoscopic and orbital approaches with repair of the orbital wall with titanium as in first case and high-density porous polyethylene sheets as in the second case. We did report some minor post-operative complications. Post-operative follow up included complete ENT and ophthalmological examination and Follow up CT. A histopathological feature of the first case is consistent with diagnosis of trabecular variant of ossifying fibroma, while the second case is consistent with the diagnosis of psammomatoid variant of ossifying fibroma. Radilogically there were partially defined expansile heterogeneous fibro-osseous mass with ground glass appearance occupying the right maxillary, ethmoidal sinuses, and the right nasal cavity and invading the orbit. Conclusion: The diagnosis of JOF is made by correlation of clinical, radiological, histopathological findings. A combined Trans- Nasal endoscopic and orbital approach is effective for adequate excision. Key Words: ossifying fibroma; juvenile aggressive ossifying fibroma; fibro-osseous lesion.