Reconstruction Of Craniofacial Defects Research Articles

Stereo lithography and Patient-specific Implants in Reconstruction of Craniofacial Defects: Institutional Experience

Stereo lithography and Patient-specific Implants in Reconstruction of Craniofacial Defects: Institutional Experience

Estimation of Titanium Levels in Blood Following Reconstruction of Post-Craniotomy Defect by Titanium Mesh Using Inductively Coupled Plasma-Optical Emission Spectroscopy (ICP-OES).

Titanium and its alloys are the most popular choice of materials for the reconstruction of craniofacial defects. They have lighter weight and are nonferromagnetic, which makes them an advantage in cranial defect reconstruction. Although the formed oxide layer makes them corrosion-resistant, levels of titanium in blood have been seen in trace amounts. This is the first study as per authors' knowledge that a study of such kind has been conducted. A pilot study was carried out at a tertiary level hospital, considering the inclusion and exclusion criteria in patients who were planned for the reconstruction of the residual defect using titanium mesh. Preoperative and 03- and 06-months postoperative blood samples were collected and analyzed for estimating the levels of titanium ions in blood by inductively coupled plasma-optical emission spectroscopy (ICP-OES). Friedman's two-way analysis of variance by ranks was considered for testing of hypothesis summary, owing to the smaller sample size. The analysis suggested an increase in levels was minimal. Considering the asymptotic significances (two-tailed significance), a significance level was 0.050, which directed us to reject the null hypothesis. Pairwise comparison suggested the presence of negative values indicating steady increase in levels. Cluster analysis indicated that although minimal there is a cluster of difference in the values at all three stages. Continuous field information was used to determine the level with regard to the level of titanium at the three stages of study. The study revealed that the levels of titanium ions increase on prolonged contact with living tissues. The trace elements have to be analyzed at regular intervals. This first-of-the-time study if extended to larger sample size would reveal interesting facts.

Stem Cell Therapy Enriched Fat Grafting for the Reconstruction of Craniofacial Deficits.

Twelve subjects with at least two regions of craniofacial volume deficit were enrolled, and they underwent fat grafting with SVF-enriched or standard fat grafting to each area. All patients had bilateral malar regions injected with SVF-enriched graft on one side and control standard fat grafting to the contralateral side. Outcome assessments included demographic information, volume retention determined by CT scans, SVF cell populations assessed by flow cytometry, SVF cell viability, complications, and appearance ratings. Follow-up was 9 months. All patients had improvement in appearance. There were no serious adverse events. There was no significant difference in volume retention between the SVF-enriched and control regions overall (50.3% versus 57.3%, P = 0.269) or comparing malar regions (51.4% versus 56.7%, P = 0.494). Patient age, smoking status, obesity, and diagnosis of diabetes did not impact volume retention. Cell viability was 77.4% ± 7.3%. Cellular subpopulations were 60.1% ± 11.2% adipose derived stem cells, 12.2 ± 7.0% endothelial cells, and 9.2% ± 4.4% pericytes. A strong positive correlation was found between CD146+ CD31-pericytes and volume retention (R = 0.863, P = 0.027). Autologous fat transfer for reconstruction of craniofacial defects is effective and safe, leading to reliable volume retention. However, SVF enrichment does not significantly impact volume retention.

THE TREATMENT OF CRANIOFACIAL GUNSHOT WOUNDS WITH INDIVIDUAL IMPLANTS

Background: Demonstrate the use of advanced three-dimensional (3D) computer technology, virtual surgical planning (VSP), three-dimensional modeling (3DM), and the treatment of complex craniofacial gunshot injuries. Methods: We present a clinical series reports of craniofacial gunshot Injuries using modern 3D computer technology. Based on the CT images of the skull, a CAD model of the skull (biomodel) and a restorative implant were digitally constructed. The biomodel was then physically constructed using 3D printing. Comparison of the dimensions of the implant and its corresponding biomodel revealed geometric correspondences. Manufactured prostheses used for the reconstruction of craniofacial defects formed after gunshot wounds. Results: There were no complications in the perioperative period, infection or exposure of the implant in the postoperative period. The results of the study showed that the imprinted individual cranial implants had a high dimensional accuracy, demonstrating clinically acceptable morphological similarity in terms of fit and contour continuity. Patients are satisfied with the aesthetic (improvement of the skull contour) and functional results of reconstruction. Conclusion: Individual implants for the reconstruction of craniofacial defects have shown effectiveness, which is associated with more accurate adaptation to the implantation site, reduced surgery time and better cosmetic effect.

Comprehensive Strategies of Flap Design for Repairing Cranium Exposure or Defects After Malignant Tumor Resection

Free tissue transfer is a great method for the reconstruction of craniofacial defects, especially in complicated situations such as calvarial defects and dura exposure. Latissimus dorsi muscle flap, anterolateral thigh flap, and radial forearm flap are 3 commonly used flaps that have distinct characteristics. The objective of the present study is to share our experiences with microvascular free flap reconstruction of cranium exposure or defects and to compare distinct microvascular free flap options. The authors reviewed 8 cases that received resection and reconstruction of craniofacial tumors. Perioperative and reconstructive techniques employed to improve flap survival, esthetic outcome, and prevent complications in these patients were retrospectively detailed. In addition, the advantages and disadvantages of latissimus dorsi muscle flap, anterolateral thigh flap, and radial forearm flap were illustrated in this study. The authors believe that taking advantage of these flaps according to the characteristics of defects and flaps will contribute to a good functional and esthetic outcome.

Microvascular Reconstruction of the Anterior Skull Base.

Anterior skull base defects present a unique reconstructive challenge. Risk factors such as previous operation, radiation and infection require a multidisciplinary approach to create a stable wound. Reconstructive microsurgery serves an important role when attempts with pericranial flap placement and nonvascularized graft obliteration fail. Our series analyzes the outcomes of 5 patients who underwent vascularized reconstruction of craniofacial defects at Northwestern Memorial Hospital from 2014-2021. Each patient presented with a complex, hostile scalp and bony wound. Common risk factors included previous craniotomy, failed obliteration, chemoradiation, osteomyelitis and epidural abscess. Patients underwent multi-stage procedures to obtain wound source control, reconstruct the frontal sinus and skull base, and frontal bone cranioplasty. Each patient underwent successful free flap reconstruction without flap loss or donor site complications. No patients suffered ongoing symptomatic CSF leak or pneumocephalus. However, only two patients have had sustained success with their alloplastic cranioplasty. A perfect, watertight seal is required to prevent seeding the implant and avoiding infection. Overall, free flap reconstruction of the skull base and frontal sinus is a necessary solution when patients fail more conservative locoregional options. Close collaboration with neurosurgery can help with diagnosis and establish the optimal timing for surgical care.

Reconstructive challenges of sinonasal tumors: A case report

Sinonasal tumors are an uncommon pathological entity and applying the optimal treatment may represent a challenge, even for experienced physicians. A various number of techniques and materials may be used in the reconstruction of craniofacial defects following surgery for extensive sinonasal cancer. The aim of the present study was to present the case of a 33-year-old male patient diagnosed with a large sinonasal tumor and discuss the challenges faced while selecting the most suitable rehabilitation technique. In the present case, it was decided that the optimal solution was to use a craniofacial prosthesis in order to cover the entire defect, as well as a temporoparietal flap. In summary, reconstructive interventions must always be adapted to each individual patient and a multimodal approach may lead to a highly satisfactory outcome, for both the patient and the surgical team. All the reconstructive solutions available must always be kept in mind and adapted to the individual requirements of each case, taking into consideration both the extent of the tumor and the comorbidities of the patient, as there is no one solution that is considered as optimal for all patients.

Augmented reality–assisted craniofacial reconstruction in skull base lesions — an innovative technique for single-step resection and cranioplasty in neurosurgery

Defects of the cranial vault often require cosmetic reconstruction with patient-specific implants, particularly in cases of craniofacial involvement. However, fabrication takes time and is expensive; therefore, efforts must be made to develop more rapidly available and more cost-effective alternatives. The current study investigated the feasibility of an augmented reality (AR)–assisted single-step procedure for repairing bony defects involving the facial skeleton and the skull base. In an experimental setting, nine neurosurgeons fabricated AR-assisted and conventionally shaped (“freehand”) implants from polymethylmethacrylate (PMMA) on a skull model with a craniofacial bony defect. Deviations of the surface profile in comparison with the original model were quantified by means of volumetry, and the cosmetic results were evaluated using a multicomponent scoring system, each by two blinded neurosurgeons. Handling the AR equipment proved to be quite comfortable. The median volume deviating from the surface profile of the original model was low in the AR-assisted implants (6.40 cm3) and significantly reduced in comparison with the conventionally shaped implants (13.48 cm3). The cosmetic appearance of the AR-assisted implants was rated as very good (median 25.00 out of 30 points) and significantly improved in comparison with the conventionally shaped implants (median 14.75 out of 30 points). Our experiments showed outstanding results regarding the possibilities of AR-assisted procedures for single-step reconstruction of craniofacial defects. Although patient-specific implants still represent the gold standard in esthetic aspects, AR-assisted procedures hold high potential for an immediately and widely available, cost-effective alternative providing excellent cosmetic outcomes.

Reconstruction of Craniofacial Bone Defects with Autologous Human Bone Marrow Stem Cells and Autogenous Bone Grafts: A Case Report with Review of Literature.

ABSTRACTReconstruction of craniofacial bony defects has always been a challenging task for the surgeons over the years. The science of reconstructing such defects is of at most importance to craniofacial and plastic surgeons due to its relevance in facial aesthetics function as well as prerequisite procedure for continuing other surgical procedures. The main goal of the reconstruction of the craniofacial defects is to reduce the morbidity by restoring the facial form and aesthetics, as well as a good function of the facial structures by achieving a reasonable occlusion and articulation. Although significant improvements have occurred during the last few decades, challenges still exist as to what type of reconstruction to be carried out with regard to techniques and the type and quality of materials of choice to be used. As decades progressed, the advancement in surgical techniques and the variety of reconstruction methods have definitely improved the quality of life. This article reviews the method of bony reconstruction of craniofacial defects using autologous human bone marrow stem cells and autologous bone grafts and its modification, which includes much recent tissue engineering techniques and regenerative medicine, thereby replacing older techniques by biological substitutes, which can restore improve and maintain orofacial function and aesthetics.

Association between metal hypersensitivity and implant failure in patients who underwent titanium cranioplasty.

Digitally designed titanium plates are commonly used for the reconstruction of craniofacial defects, although implant exposure (referred to as failure) is one of the major complications. Metal hypersensitivities have been suggested as possible causes of implant failure of orthopedic, intravascular, gynecological, and dental devices, yet there has been no consensus on the requirement for allergy screening before cranioplasty. In this study, the authors prospectively investigated the prevalence of metal hypersensitivity in patients for whom cranioplasty is planned and assess its relationship with titanium implant failure (exposure). Based on records from 207 included patients, 39.61% of patients showed hypersensitivity to at least one kind of metal. Approximately one-quarter (25.12%) of patients had multiple metal allergies. Co, Cd, and Zn were the 3 most frequently identified metal hypersensitivities. No allergy to titanium was detected in this study. The overall incidence of cranioplasty implant failure was 5.31% (11 of 207). Patients showing hypersensitivities to more than 3 kinds of metal had higher risks of titanium plate exposure. Based on their findings, the authors suggest that routine allergy screening be performed before titanium plate cranioplasty. For patients with hypersensitivities to more than 3 metals, alternative materials, such as polyetheretherketone, should be considered for cranioplasty.

The use of microsurgical reconstruction in treatment of craniofacial defects in paediatric patients

Background: Reconstruction of craniofacial defects with the use of microvascular free flaps is currently a golden standard of reconstructive surgery in subjects with post-resection, post-traumatic and congenital tissue defects. Although microsurgical techniques are quite common in adult treatment, they are much less frequently used in paediatric patients. In juvenile patients, defects of skeleton and soft facial tissues are most frequently related to congenital defects (facial clefts, congenital applasias), resection of neoplastic tumours. The most serious include disorders in craniofacial growth and development resulting from damage to growth centres and loss of the main tissue mass. This leads to impaired ratio of facial to cerebral skull and to the remaining structures, which causes big difficulties during secondary reconstruction procedures and has a negative effect on the final functional and aesthetic effect. Additionally, defects of craniofacial tissue are very often related to impaired anatomy of the stomatognathic system (teeth, maxillary alveolar bones and bones of the alveolar part of the mandible, muscles of mastication and temporomandibular joints). The use of microsurgical techniques in craniofacial reconstruction procedures allows reconstruction of the oral cavity tissue base, which in turn enables rehabilitation of the stomatognathic system structure at the earliest possible time, also with the use of implantoprosthetic techniques. This creates proper growth impulses for further craniofacial development following a reconstruction procedure.

Head and neck microsurgical reconstruction using the superficial temporal vein for antegrade and retrograde drainage: A clinical case series

In head and neck microsurgical reconstruction, previous surgery and past radiation exposure to the neck may adversely affect recipient vessel access in the neck. The superficial temporal vessels can be used to overcome these challenges. The purpose of this article is to demonstrate the viability of using the superficial temporal vein (STV) for a double venous anastomosis, for antegrade and retrograde drainage, in head and neck microvascular free flap transfers. An 11-year retrospective chart review was performed of clinical cases of head and neck reconstruction by free tissue transfer, in which the recipient vessels used were the superficial temporal artery (STA) and vein, with the latter providing for dual antegrade and retrograde drainage. The case series comprised of six patients who underwent free flap reconstruction of craniofacial defects following resection of malignant tumours in five, and due to noma in one. Compromising factors were scarring, radiotherapy, previous surgery and the recipient superficial temporal vein being less than 1 mm in diameter above the parotid. The recipient vessels used were the superficial temporal artery and veins in all cases. The use of the superficial temporal blood supply for a single arterial supply and a dual antegrade and retrograde venous drainage is a reliable technique for free flaps to the upper two thirds of the head. A double venous anastomosis adds to its dependability. Level of Evidence: Level IV, therapeutic study.

Applications of Computer Technology in Complex Craniofacial Reconstruction.

Background:To demonstrate our use of advanced 3-dimensional (3D) computer technology in the analysis, virtual surgical planning (VSP), 3D modeling (3DM), and treatment of complex congenital and acquired craniofacial deformities.Methods:We present a series of craniofacial defects treated at a tertiary craniofacial referral center utilizing state-of-the-art 3D computer technology. All patients treated at our center using computer-assisted VSP, prefabricated custom-designed 3DMs, and/or 3D printed custom implants (3DPCI) in the reconstruction of craniofacial defects were included in this analysis.Results:We describe the use of 3D computer technology to precisely analyze, plan, and reconstruct 31 craniofacial deformities/syndromes caused by: Pierre-Robin (7), Treacher Collins (5), Apert’s (2), Pfeiffer (2), Crouzon (1) Syndromes, craniosynostosis (6), hemifacial microsomia (2), micrognathia (2), multiple facial clefts (1), and trauma (3). In select cases where the available bone was insufficient for skeletal reconstruction, 3DPCIs were fabricated using 3D printing. We used VSP in 30, 3DMs in all 31, distraction osteogenesis in 16, and 3DPCIs in 13 cases. Utilizing these technologies, the above complex craniofacial defects were corrected without significant complications and with excellent aesthetic results.Conclusion:Modern 3D technology allows the surgeon to better analyze complex craniofacial deformities, precisely plan surgical correction with computer simulation of results, customize osteotomies, plan distractions, and print 3DPCI, as needed. The use of advanced 3D computer technology can be applied safely and potentially improve aesthetic and functional outcomes after complex craniofacial reconstruction. These techniques warrant further study and may be reproducible in various centers of care.

Individual titanium zygomatic implant

Custom individual implants for the reconstruction of craniofacial defects have gained importance due to better qualitative characteristics over their generic counterparts – plates, which should be bent according to patient needs. The Additive Manufacturing of individual implants allows reducing cost and improving quality of implants. In this paper, the authors describe design of zygomatic implant models based on computed tomography (CT) data. The fabrication of the implants will be carried out with 3D printing by selective laser melting machine SLM 280HL.

Reconstruction orbito-frontale osseuse sur mesure par guides de coupes

Reconstruction of craniofacial defects due to traumatic injuries is a challenge for a reconstructive surgeon, given the functional impact, the aesthetic impact and the geometric complexity of the craniofacial skeleton. The use of cutting and repositioning guides enables a new approach from the craniofacial reconstruction with bone grafts on measure. We are presented to illustrate this technique the case of a patient. The patient was 50 years old, he presented a traumatic facial sequelar: a left frontal craniofacial deformation, an enlarged left orbit with enophthalmos and valgus left zygoma. The patient had a permanent diplopia, an important aesthetic and social gene impeding daily life. Surgical planning was performed for optimal care. We performed a cranioplasty frontotemporal by bone parietal duplication, osteotomy of zygoma and intra-orbital bone graft customized using cutting guides. The bone pieces were positioned with the repositioning books. This presentation illustrates a novel application of cutting guides. This technique has the advantage of using customized autologous bone. This is the gold standard, it requires surgical experience.

Optimal Murine Cranial Defect Reconstruction Utilizing a Novel Collagen Scaffold and rhBMP2 with Analysis Utilizing Confocal Microscopy

INTRODUCTION: Although tremendous advancements in the surgical reconstruction of craniofacial defects have been made, a large proportion of patient outcomes remain unfavorable. Patients with combat and civilian trauma, craniectomy for various intracranial pathologies and large en-bloc tumor resections are often left with few reconstructive options. Technical challenges that exist in the reconstruction of larger, more complex craniofacial defects are pronounced due to a higher incidence of infection, soft tissue erosion, extrusion, and migration. This study aims to further delineate the role of bone morphogenetic protein-2 (rhBMP2) by determining the smallest dose required for maximal bone regeneration when delivered in a novel collagen scaffold. METHODS: Utilizing a murine model, C57BL/6 (n=) mice received two identical 5mm full-thickness craniectomy defects (61.6 mm2) using a standardized micro-drill core bit. The mice were divided into 10 groups consisting of: craniectomy only (Group 1, n=3), craniectomy with doses of 0.1µg rhBMP2 (Group 2, n=3), 1.0µg rhBMP2 (Group 3, n=3), 2.5µg rhBMP2 (Group 4, n=3), 5.0µg rhBMP2 (Group 5, n=3), craniectomy with collagen only (Group 6, n=3), and craniectomy, collagen and doses of 0.1µg rhBMP2 (Group 7, n=5), 1.0µg rhBMP2 (Group 8, n=5), 2.5µg rhBMP2 (Group 9, n=5), 5.0µg rhBMP2 (Group 10, n=5). Mice underwent CT imaging at 2 and 8 weeks to assess volumetric calvarial bone regeneration and explant analysis at 8 weeks using confocal microscopy. RESULTS: The mice in Group 1 (craniectomy only), Groups 2-5 (craniectomy plus rhBMP2) and Group 6 (craniectomy plus collagen) showed appreciable but little total percent defect healing at 8 weeks (Group 1=1%, Group 2=9%, Group 3=12%, Group 4=13%, Group 5=19%, and Group 6=4%). Groups 7-10 (craniectomy plus collagen plus rhBMP2) showed a much higher stepwise increase in total percent of defect healed (Group 7=19%, Group 8=23%, Group 9=31%, and Group 10=38%). Additionally, a stepwise increase in total hydroxyapatite aggregates and hydroxyapatite aggregate size was observed in Groups 2-5, and Groups 6-10. Maximum angiogenesis was seen in Group 8. CONCLUSIONS: Current surgical reconstruction of large craniofacial defects remains challenging and associated with a high incidence of complications. The determination of an optimal dose of rhBMP2 delivered in a novel collagen scaffold, as outlined here in a murine cranial defect, facilitates further evaluation of rhBMP2 when used alone or in combination with other biologic products to reconstruct large craniofacial defects.

Expansores tisulares en reconstrucción de defectos craneofaciales: estudio multicéntrico retrospectivo

Our goal is to describe and analyze the use of tissue expanders for reconstruction of craniofacial defects in 3 highly complex centers in the country (Chile)...

Tissue-engineered cartilage for facial plastic surgery.

The reconstruction of cartilaginous craniofacial defects is ideally performed with analogous grafting material, such as autologous tissue. However, the use of autologous cartilage is limited by its finite availability and potentially suboptimal geometry to repair specific defects. Tissue engineering of human cartilage may provide the adequate supply of grafting and implant material for the reconstruction of cartilaginous facial defects. An update of the various cartilage tissue engineering methodologies is provided in this review. The cartilage tissue engineering paradigm begins with the harvest of a small septal cartilage donor specimen. This is followed by the isolation and subsequent proliferation of chondrocytes and the seeding of these cells onto three-dimensional scaffolds. Neocartilage is created as pericellular substrate, is produced by the cells and deposited throughout the scaffold. Theoretically, the mature cartilage construct can be introduced back into the same patient for reconstruction of craniofacial defects. Initial steps of the cartilage tissue engineering protocol have been standardized; however, modifications of subsequent steps have shown the potential to profoundly impact tissue composition and strength, bringing the properties of cartilage constructs closer to those of native human septum. The ability to engineer virtually limitless quantities of autologous cartilage could have a profound impact on facial plastic and reconstructive surgery. The strategies used to refine human cartilage culture techniques have successfully produced neocartilage constructs with biochemical and biomechanical properties approaching those of native septal tissue. With the steady progress achieved in recent years, there is great capacity for the proximate realization of surgically implantable tissue-engineered cartilage constructs.

Exchange Hybrid Cranioplasty Using Particulate Bone Graft and Demineralized Bone Matrix

Reconstruction of craniofacial defects in children presents several challenges that are not encountered in the adult population. Autologous bone grafts have long been the criterion standard for repairing these defects. Recently, several new materials and techniques have expanded our arsenal of reconstructive options. In this clinical report, we describe the use of both particulate bone grafting and demineralized bone matrix together to repair craniofacial defects encountered in pediatric patients.

One-Year Volume Stability of Human Facial Defects Filled With a β-Tricalcium Phosphate–Hydroxyl Apatite Mixture (Atlantik)

We investigated the applicability and 1-year stability of a β-tricalcium phosphate-hydroxyl apatite mixture (Atlantik) for secondary reconstruction of craniofacial defects and the application of OsiriX in evaluating bone and implant volumes. We included 6 patients (25-59 years) with craniofacial defects. A computed tomography scan was made preoperative, directly postoperative, and at least 1 year postoperative to evaluate volume changes. OsiriX was used to quantify volumes of the implanted Atlantik. Measurements were performed by 2 independent investigators and analyzed by calculating both Pearson correlation and interclass correlation coefficient. After 1 year, the mean volume reduction of the implanted Atlantik was 9.8%. The absolute volume reduction in 1 year was 0.38 cm (range, 0.10-0.69 cm(3)). Pearson correlation test was 0.996, with a significance level of P < 0.01, and the interclass correlation coefficient was 0.998. Atlantik is a stable osteoconductive material for the repair of various craniofacial defects. There is a reduction of only 10% of the augmented volume in the long term. Applying OsiriX for computed tomography image volume analysis proved to be a well-reproducible technique.