Titanium Mesh Plate Research Articles

Patient-specific titanium mesh plate for the reconstruction of complex nasoethmoid-orbital and midfacial bone fractures due to bear injury

Patient-specific titanium mesh plate for the reconstruction of complex nasoethmoid-orbital and midfacial bone fractures due to bear injury

Ultraviolet treatment restores bioactivity of titanium mesh plate degraded by contact with medical gloves.

Titanium mesh plate (Ti mesh) used for bone augmentation inadvertently comes into contact with medical gloves during trimming and bending. We tested the hypotheses that glove contact degrades the biological capability of Ti mesh and that ultraviolet treatment (UV) can restore this capability. Three groups of Ti mesh specimens were prepared: as-received (AR), after glove contact (GC), and after glove contact followed by UV treatment. The AR and GC meshes were hydrophobic, but GC mesh was more hydrophobic. AR and GC meshes had significant amounts of surface carbon, and Si content was higher for GC mesh than for AR mesh. UV mesh was hydrophilic, and carbon and silicon content values were significantly lower in this group than in the AR and GC groups. The number, alkaline phosphatase activity, and mineralization ability of attached osteoblasts were significantly lower in the GC group than in the AR group and markedly higher in the UV group than in the AR group. In conclusion, glove contact caused chemical contamination of Ti mesh, which significantly reduced its bioactivity. UV treatment restored bioactivity in contaminated Ti mesh, which outperformed even the baseline Ti mesh.

Anatomical Thin Titanium Mesh Plate Structural Optimization for Zygomatic-Maxillary Complex Fracture under Fatigue Testing

This study performs a structural optimization of anatomical thin titanium mesh (ATTM) plate and optimal designed ATTM plate fabricated using additive manufacturing (AM) to verify its stabilization under fatigue testing. Finite element (FE) analysis was used to simulate the structural bending resistance of a regular ATTM plate. The Taguchi method was employed to identify the significance of each design factor in controlling the deflection and determine an optimal combination of designed factors. The optimal designed ATTM plate with patient-matched facial contour was fabricated using AM and applied to a ZMC comminuted fracture to evaluate the resting maxillary micromotion/strain under fatigue testing. The Taguchi analysis found that the ATTM plate required a designed internal hole distance to be 0.9 mm, internal hole diameter to be 1 mm, plate thickness to be 0.8 mm, and plate height to be 10 mm. The designed plate thickness factor primarily dominated the bending resistance up to 78% importance. The averaged micromotion (displacement) and strain of the maxillary bone showed that ZMC fracture fixation using the miniplate was significantly higher than those using the AM optimal designed ATTM plate. This study concluded that the optimal designed ATTM plate with enough strength to resist the bending effect can be obtained by combining FE and Taguchi analyses. The optimal designed ATTM plate with patient-matched facial contour fabricated using AM provides superior stabilization for ZMC comminuted fractured bone segments.

Development of a novel anatomical thin titanium mesh plate with reduction guidance and fixation function for Asian zygomatic-orbitomaxillary complex fracture

For this study we developed an anatomical thin titanium mesh (ATTM) plate for Asian zygomaticomaxillary complex (ZMC) fracture repair with reduction guidance and fixation function. The ATTM plate profile was designed as an L-shape to fix at the anterior maxilla and lateral buttress of the ZMC. Computer-aided stamping analysis was performed on four screw-hole patterns in the ATTM plate — a control without screw-holes, square screw-holes, double screw-holes, and large-diameter, double screw-holes — using upper/lower dies of averaged ZMC reconstruction models. A regular ATTM plate of 0.6 mm thickness was manufactured and pre-bent using a patient-matched stamping process to verify its feasibility on three ZMC fracture models with one, two, and three fracture segments. The stamping analysis found that the double screw-holes design resulted in the most favorable performance among all the designs because of maximum von Mises stress (408 MPa) under the ultimate tensile strength. Positioning practice showed that the stamped, pre-bent ATTM plate can be used as a reduction guide to provide precise ZMC segment fixation in a completely passive fashion while limiting redundant rotation/micromovement between the separate bones in all directions.This study concluded that the ATTM plate with double screw-hole pattern design, using a patient-matched, pre-bent technique, can fit the ATTM plate/ZMC interface well, decrease mobility of unstable fracture segments, and provide good original facial contour recovery, while improving reduction efficiency.

Tensile behaviors of three-dimensionally free-formable titanium mesh plates for bone graft applications

Present metal artificial bones for bone grafts have the problems like too heavy and excessive elastic modulus compared with natural bones. In this study, three-dimensionally (3D) free-formable titanium mesh plates for bone graft applications was introduced to improve these problems. Fundamental mesh shapes and patterns were designed under different base shapes and design parameters through three dimensional CAD tools from higher flexibility and strength points of view. Based on the designed mesh shape and patterns, sample specimens of titanium mesh plates with different base shapes and design variables were manufactured through laser processing. Tensile properties of the sample titanium mesh plates like volume density, tensile elastic modulus were experimentally and analytically evaluated. Experimental results showed that such titanium mesh plates had much higher flexibility and their mechanical properties could be controlled to close to the natural bones. More details on the mechanical properties of titanium mesh plates including compression, bending, torsion and durability will be carried out in future study.

Modified Anterior Craniofacial Osteotomy Using Partial Nasal Bone Division and Reconstruction in Frontoethmoidal Sinus Meningioma.

Typical transcranial approaches are insufficient for adequate visualization and resection of skull base tumors. Different approaches with multiple modifications have been attempted. Here, we describe a new approach for a lesion that is central and hard to treat by conventional craniotomy and successful reconstruction with calvarial bone graft and titanium mesh plate. A 69-year-old female patient presented with recurrent meningioma. The tumor had invaded the frontal lobe, right supraorbital rim, and ethmoidal bone. We performed a modified anterior craniofacial approach that fully exposed the tumor and invaded bone. In consideration of the patient's age and cosmetic result, the tumor and invaded bone was resected and the defect area was reconstructed with titanium mesh and calvarial bone graft. At 6 months postoperative the patient had no complications and was satisfied with the esthetic result. We report this case to demonstrate the successful approach and reconstruction using this technique.

Anterior decompression and hybrid reconstruction with titanium mesh cage plus plate and self-locking stand-alone cage for the treatment of three-level cervical spondylotic myelopathy

It has been reported that anterior cervical decompression has good clinical outcomes for the treatment of adjacent three-level cervical spondylotic myelopathy (CSM). However, the application of a long plate in the anterior cervical spine poses substantial risks of soft tissue damage. In this retrospective study, we aimed to analyze the clinical and radiological results of the hybrid construction with titanium mesh cage (TMC) plus plate and self-locking stand-alone cage for treatment of adjacent three-level CSM. A total of 28 consecutive patients with adjacent three-level CSM were treated by anterior decompression and hybrid reconstruction with TMC plus plate and self-locking stand-alone cage. Clinical outcomes, complications, fusion rate and time, cage subsidence and spinal curvature were assessed. The mean follow-up period was 22.8months. The average operative time was 103±18.5min, and the average blood loss was 115±13.3mL. The JOA score and degree of spinal curvature were significantly increased at the final follow-up compared with preoperatively (P<0.05). Twenty-seven cases finally achieved a solid fusion, and the average time to achieve a solid fusion was 6.2months. Postoperative complications included one case of cerebrospinal fluid leakage (3.57%), one case of temporary sore throat (3.57%) and two cases of TMC subsidence (7.1%). No dysphagia and hoarseness were observed. Anterior decompression and hybrid reconstruction with TMC plus plate and self-locking stand-alone cage could be used safely and effectively for the treatment of adjacent three-level CSM. It could effectively restore cervical lordosis, reduce the complications related to long plate fixation, and lead to satisfactory outcomes.

Treatment of Orbital Fractures with Orbital-Wall Defects using Anatomically Preformed Orbital Wall Reconstruction Plate System

This retrospective study evaluated the utility of an orbital wall reconstruction plate system for orbital fractures with relatively large orbital-wall defects. We analyzed the clinical and radiological data of seven patients with orbital fractures. All of the patients suffered midfacial trauma with fractures extending to the orbit. Ophthalmologists diagnosed functional eye complications, including diplopia, enophthalmos, restricted eyeball mobility, and reduced globe motility. The fractures with orbital-wall defects were located in the orbital floor in four (57.1%) and the floor/medial wall in three (42.9%). A 0.4-mm-thick orbital wall reconstruction plate (anatomically preformed titanium mesh plate system) was used for orbital reconstruction together with midfacial fracture reduction with stable internal fixation at the inferior orbital rim. The fractures were assessed preoperatively using computed tomography (CT). The accuracy of the three-dimensional (3D) reconstructed orbital volume with the correct positioning of the anatomically preformed titanium mesh plate system was assessed postoperatively with CT. All of the patients had satisfactory clinical results with no complications associated with this system and the open reduction and internal fixation. There was full recovery of ophthalmological function and active eyeball mobility, without enophthalmos or diplopia. The postoperative CT data showed that the injured orbits had been corrected anatomically based on a precise postoperative 3D volume reconstruction using this system. There was no significant difference compared with the uninjured orbital 3D volume. In conclusion, the reconstruction of orbital wall fractures related to midfacial factures with the anatomically preformed titanium mesh plate system for the orbital reconstruction is a promising surgical technique.

Calvarial aneurysmal bone cyst associated with fibrous dysplasia: Case report and literature review

Abstract Aneurysmal bone cysts are benign, expansile bone lesions primary or secondary to other pathology. The majority are seen in long bones and the spine, rarely occurring within the cranial vault. Here we describe the case of a 17-year-old gentleman with McCune-Albright syndrome who developed a right parietal aneurysmal bone cyst in the setting of fibrous dysplasia. The patient was treated with lesion excision and in situ cranioplasty using methyl methacrylate and molded titanium mesh, ultimately rendering excellent cosmetic outcome. Our case report highlights the efficacy of in situ titanium cranioplasties in contouring to the native skull and enabling optimization of cosmesis, specifically through the use of titanium mesh plates with the bone flap as a template.

Nasal gouty tophus: Report a rare case presenting as a nasal hump with nasal obstruction

Dorsal nasal gouty tophus are rare occurrences with limited documentation. Here we report a male patient who has a history of poorly controlled gouty arthritis. He had nasal obstruction with an enlarging mass over his left nasal ridge for the past three years. Image studies revealed a nasal bone defect underneath the nasal lesion. The firm mass was excised and confirmed to be of gouty origin. The nasal bone defect was repaired with a titanium mesh plate to prevent nasal depression. He has fully recovered with no more nasal obstruction or recurrence of nasal tophus. The case report illustrates a common illness, gout, with a rare clinical manifestation leading to a common symptom, nasal obstruction. It demonstrates the importance of a detailed history, a thorough physical examination and most important of all, an extensive differential diagnosis in our clinical practice.

Can customized implants correct enophthalmos and delayed diplopia in post-traumatic orbital deformities? A volumetric analysis

The purpose of this study was to determine whether orbital reconstruction with customized implants can correct post-traumatic orbital deformities such as late enophthalmos and delayed diplopia. The hypothesis proposed was that an overcorrection of the orbital volume is needed to resolve enophthalmos. A retrospective observational descriptive study was conducted. Patients with a major trauma who required customized orbital implants for the delayed treatment of unilateral orbital fractures that had initially been operated on using titanium mesh and/or osteosynthesis plates were included. The orbital volumes of the unaffected contralateral side, of the affected orbit after initial reconstruction with mesh, and of the affected orbit subsequently reconstructed with the customized implant were calculated. All of the patients included in this study had diplopia in the gaze position prior to the installation of the implant. In addition, they all had severe enophthalmos. After surgery, no patient with a customized implant showed diplopia. The enophthalmos was corrected in all but one case. On average, orbits reconstructed with customized implants had lower volumes compared to the unaffected contralateral side. In cases where the enophthalmos was resolved, the volume was reduced by an average of 8.55%. Further studies using a larger number of cases and with controlled volumetric corrections using CAD/CAM are needed.

A case of prothorax soft tissue sarcoma for which a titanium mesh plate was useful

A case of prothorax soft tissue sarcoma for which a titanium mesh plate was useful

Treatment of Orbital Medial Wall Fractures with Titanium Mesh Plates Using Retrocaruncular Approach: Outcomes with Different Techniques.

Surgical management of medial wall orbital fractures should be considered to avoid diplopia and posttraumatic enophthalmos. Treatment of these fractures remains a challenge for the maxillofacial surgeon because of complex anatomy and limited vision. This article aims to retrospectively evaluate the outcomes in the repair of medial orbital wall fractures using a retrocaruncular approach and titanium meshes, comparing the placement of the titanium mesh with three different techniques: (1) conventional free hand under direct vision, (2) with the assistance of an endoscope, and (c) with the assistance of a navigation system. Eighteen patients who underwent surgery for orbital medial wall fracture were enrolled in the study. On the basis of the implant placement technique, three groups were identified: group 1 (CONV), conventional free hand under direct vision; group 2 (ENDO), endoscopically assisted; group 3 (NAVI), a navigational system assisted (BrainLab, Feldkirchen, Germany). The postoperative quality of orbital reconstruction was assessed as satisfactory in 12 cases, good in 4 cases, and unsatisfactory in 2 cases. Particularly in group 1 (CONV) in four patients out of eight, the posterior ledge of the fracture was not reached by the implant and in one patient the mesh hinged toward the ethmoid. In group 3 (NAVI), in one patient out of five, the posterior ledge of the fracture was not reached. In conclusion, titanium orbital mesh plates and retrocaruncular approach are a reliable method to obtain an accurate orbital medial wall reconstruction. The use of endoscopic assistance through the surgical incisions improves accuracy of treatment allowing better visualization of the surgical field. Navigation aided surgery is a feasible technique especially for complex orbital reconstruction to improve predictability and outcomes in orbital repair.

Anterior surgical treatment of 4-level cervical spondylotic myelopathy

Objective To investigate the clinical results, neurological scores, radiographic changes and complications for patients with 4-level cervical spondylotic myelopathy(4-level CSM) who underwent anterior decompression and fusion surgery. Methods All the medical records of anterior cervical surgery in our hospital between September 2006 and March 2014 were collected. Among them, thirty-two consecutive patients with 4-level CSM underwent the anterior decompression and fusion procedures were retrospectively investigated. Neurological function was measured at different times using Japanese Orthopedic Association(JOA) scores. The visual analogue score(VAS) was recorded for neck-shoulder pain evaluation. X-rays were conducted before and after surgery for cervical lordosis and fusion rate. Complications such as iliac pain, dysphonia, C5 palsy, cerebral fluid leakage, axial neck pain and temporary dysphagia were recorded and analyzed as well. Results All the operations were performed uneventfully. The mean operative time was 136±18min and mean blood loss was 67±16ml. The overall follow-up period of the patients ranged from 1-8 years(average 3.6±1.7years). The VAS score significantly decreased from 7.3±1.2 preoperatively to 3.6±0.8 at 12 months postoperatively. The JOA score was 9.2±1.6 preoperatively, and 9.6±2.2, 12.5±3.3, 13.2±3.2, 13.7±3.4 at 1 week, 3 months, 6 months and 12 months postoperatively. Autologous iliac bone grafts were used in 4 patients, whose fusion rate was 100% at 6 months postoperatively. Titanium meshes were used in 28 patients, whose fusion rate was 85.7% at 6 months postoperatively and 100% at 12 months postoperatively. No hardware-related complications such as screw pull-out or plate bending occurred during the short-or long-term follow-up. Complications included iliac pain(3 cases), dysphonia(1 case), C5 palsy(1 case), cerebral fluid leakage(2 cases), axial neck pain(5 cases) and temporary dysphagia(1 case). Conclusion Anterior approach for 4-level CSM is a challenging surgical technique. The choice of corpectomy levels should depend on the characteristics of cord compression. C4 and C6 discontinuous corpectomy with titanium mesh graft fusion and plate fixation is recommended procedure. This technique will be safe and effective if proper decompression and steady fixation are guaranteed. Key words: Cervical vertebrae; Spinal cord compression; Spinal fusion; Postoperative complications

Cranioplasty and Duraplasty with Transcranial Color-Coded Duplex Sonography after Aneurysmal Subarachnoid Hemorrhage

Transcranial color-coded duplex sonography (TCCS) is a noninvasive technique for monitoring of cerebral vasospasm after neurosurgery for aneurismal subarachnoid hemorrhage. In this surgery, surgical materials are used. The goal of the study was to identify materials that can be used with ultrasound and to propose methods for cranioplasty and duraplasty using materials that permit TCCS. The chosen neurosurgical materials were titanium mesh plate (TMP), Gore-tex, SEAMDURA, gelatinous sponge, and oxidized cellulose. B-mode imaging was recorded with the materials placed between urethane resin 10 mm in diameter and the urethane phantom model. TCCS was performed to detect middle cerebral artery flow through TMP and Gore-tex. TMP and SEAMDURA permitted penetration of ultrasound in B-mode and Doppler imaging, but the other materials did not do so. A postcraniotomy window (PCW) on a line extending from the horizontal portion of M1 using only TMP permitted flow imaging with TCCS. In external decompression, TCCS was effective only without use of Gore-tex around the postcraniotomy window. This method allows the middle cerebral artery flow to be detected easily.

Modifications of the deep circumflex iliac artery free flap for reconstruction of the maxilla

The deep circumflex iliac artery (DCIA) free flap remains underused in maxillectomy reconstruction. A number of surgical techniques have been described however, maxillary defects vary greatly and modifying techniques to account for such variation can be challenging. This article presents the first standardized approach to DCIA free flap modification for maxillary reconstruction where graded modifications are made to a standard procedure based on defect grade. A review of 11 cases that underwent maxillectomy reconstruction with this technique is presented. Defect complexity is stratified according to the Brown Classification System and graded modifications of increasing complexity are made to a standard harvest and flap inset technique. Modifications include increasing the depth of the harvested iliac crest bone to correspond to the height of the anterior maxillary wall defect, addition of a titanium mesh plate to reconstruct the orbital floor and harvest of the internal oblique muscle to fill the orbital cavity. Short and long-term outcomes and complications of 11 cases that underwent maxillectomy reconstruction according to this technique were documented. Defects ranged from Brown Class I-IV, b-c. All but two patients had malignant diagnoses with squamous cell carcinoma (n = 5) being the most prevalent. Short-term flap related complications were neck cellulitis (n = 1) and donor site haematoma (n = 2) whilst long-term flap related complications were mild trismus (n = 1) and donor site pain (n = 1). There were no reported problems with speech, swallowing or vision. This stepwise approach to DCIA free flap modification for maxillectomy defect reconstruction may be used as a guide for future maxillary reconstruction.

The effect of titanium mesh implantation for the treatment of enophthalmos secondary to inferior orbital wall fracture

Objective To evaluate the effect ofSshaped titanium mesh implantation on orbit floor for enophthalmos secondary to inferior orbital wall fracture. Methods The surgical effects of 17 eyes of 17 cases inferior orbital wall fracture who receivedSshaped titanium mesh implantation on orbit floor for orbital wall reconstruction were analyzed retrospectively. Preoperatively, there were 9 cases with enophthalmos between 2 to 3 mm, 8 cases with enophthalmos between 3.5 to 4.5 mm, 3 cases with diplopia, 2 cases with apparent vertical globe dystopia. For all the cases, an inferior subciliary approach was performed, aSshaped titanium mesh plate was implanted under the periosteum to cover the area of the inferior orbital wall fracture for reconstruction of the orbital cavity. Results Postoperatively, on the follow-up period of 6-12 months, the enophthalmos of all cases was corrected to less than 2mm successfully, the preoperative diplopia disappeared in all the 3 cases, the vertical globe dystopia of 2 eases disappeared, and no visual complication was observed. No complication of infection, extrusion, rejection or migration of the implants occurred, however mild low eyelid retraction occurred in 1 case and disappeared at 8 month postoperatively. Conclusion Sshaped titanium mesh plate implantation in orbital reconstruction for correcting enophthalmos secondary to inferior orbital wall fracture is safe and effective. Key words: Fractures, orbital, inferior wall; Enophthalmos; Titanium mesh,S shaped; Implantation

The Concept of Prosthetically Guided Maxillofacial and Implant Surgery for Maxillary Reconstruction.

The Concept of Prosthetically Guided Maxillofacial and Implant Surgery for Maxillary Reconstruction.

Monte Carlo simulation and film dosimetry for electron therapy in vicinity of a titanium mesh.

Titanium (Ti) mesh plates are used as a bone replacement in brain tumor surgeries. In the case of radiotherapy, these plates might interfere with the beam path. The purpose of this study is to evaluate the effect of titanium mesh on the dose distribution of electron fields. Simulations were performed using Monte Carlo BEAMnrc and DOSXYZnrc codes for 6 and 10 MeV electron beams. In Monte Carlo simulation, the shape of the titanium mesh was simulated. The simulated titanium mesh was considered as the one which is used in head and neck surgery with a thickness of 0.055 cm. First, by simulation, the percentage depth dose was obtained while the titanium mesh was present, and these values were then compared with the depth dose of homogeneous phantom with no titanium mesh. In the experimental measurements, the values of depth dose with titanium mesh and without titanium mesh in various depths were measured. The experiments were performed using a RW3 phantom with GAFCHROMIC EBT2 film. The results of experimental measurements were compared with values of depth dose obtained by simulation. In Monte Carlo simulation, as well as experimental measurements, for the voxels immediately beyond the titanium mesh, the change of the dose were evaluated. For this purpose the ratio of the dose for the case with titanium to the case without titanium was calculated as a function of titanium depth. For the voxels before the titanium mesh there was always an increase of the dose up to 13% with respect to the same voxel with no titanium mesh. This is because of the increased back scattering effect of the titanium mesh. The results also showed that for the voxel right beyond the titanium mesh, there is an increased or decreased dose to soft tissues, depending on the depth of the titanium mesh. For the regions before the depth of maximum dose, there is an increase of the dose up to 10% compared to the dose of the same depth in homogeneous phantom. Beyond the depth of maximum dose, there was a 16% decrease in dose. For both 6 and 10 MeV, before the titanium mesh, there was always an increase in dose. If titanium mesh is placed in buildup region, it causes an increase of the dose and could lead to overdose of the adjacent tissue, whereas if titanium mesh is placed beyond the buildup region, it would lead to a decrease in dose compared to the homogenous tissue.PACS number: 87.53.Bn

Titanium mesh-assisted dural tenting for an expansile suboccipital cranioplasty in the treatment of Chiari 1 malformation

Cerebellar ptosis and dural prolapse are known complications after posterior craniocervical decompression of Chiari 1 malformation (CM1), and are associated with larger craniectomies, epidural scarring and intradural adhesions. Although management of these complications has been well documented, little has been reported in regards to their prevention. We describe our variation of the posterior fossa decompression technique for CM1 using a titanium mesh-assisted dural tenting expansile cranioplasty to prevent both cerebellar ptosis and dural prolapse. A watertight dural augmentation patch is performed after posterior craniocervical decompression. A titanium mesh cranioplasty is performed to cover the superior aspect of the craniectomy. The duraplasty is then tented to the titanium mesh plate with several interrupted sutures. The titanium mesh plate was intended to prevent postoperative cerebellar ptosis or sag, while the dural tenting was performed to prevent delayed collapse and restenosis of the cistern magna. Four patients with CM1 underwent this technique without complication. Postoperative MRI did not demonstrate cerebellar ptosis, restenosis or collapse of the cisterna magna. The expansile suboccipital cranioplasty with titanium mesh-assisted dural tenting technique is a simple and efficient strategy that may be useful to prevent cerebellar ptosis and dural prolapse and maintain the patency of the surgically created neo-cisterna magna.