Titanium Mesh Plate Research Articles

Treatment of hematomas in operation area after anterior approach surgery for cervical spondylosis

Objective To investigate the treatment and prevention strategies of hematomas in operation area after anterior approach surgery for cervical spondylosis.Methods A retrospective review was conducted on 12 with hematoma compression in operation area out of 785 patients managed by anterior cervical surgery from January 2007 to July 2013,including 10 males and 2 females at age ranging from 40-71 years (mean 56.8 years).Surgery method was anterior cervical corpectomy and interbody fusion using titanium mesh cage plus plate and intraoperative blood loss was 300-1 200 ml.Primary clinical manifestations were neurological dysfunction in 5 patients,dyspnea in 6,and both neurological dysfunction and dyspnea in 1.There were 10 patients with the presence of symptoms at postoperative 0.5-22 hours,1 at postoperative 73 hours,and 1 at postoperative 74 hours.All the 12 patients underwent a second anterior cervical exploration.Results There were 5 patients with epidural hematoma,6 with subcutaneous hematoma,and 1 with both hematomas.After surgical interventions,the patients presented improvement in respiratory and neurological function,with inapparent respiratory abnormality and improved neurological function at discharge.One patient was died of cardiovascular-associated disease after being discharged from hospital.The left 11 patients were followed up for mean 19.8 months (range,6-43 months),with improved Japanese Orthopedic Association (JOA) score at final follow-up.Conclusions Hematoma took place frequently in the early period,especially within 24 hours in operation area after anterior approach to cervical disorders and close attention should be paid to respiratory and limb sensation and motion functions.Early detection and early surgical interventions are the key countermeasures to avoiding the severe results. Key words: Cervical vertebrae ; Hematoma; Surgical procedures, operative

インプラント用3次元自由成形チタンメッシュプレートの創製（メッシュ構造によるチタンメッシュプレートの考案）

インプラント用3次元自由成形チタンメッシュプレートの創製（メッシュ構造によるチタンメッシュプレートの考案）

Aesthetic Correction of a Protrusive Forehead through Repositioning of the Anterior Wall of the Frontal Sinus.

Facial skeletal remodeling was revolutionized more than 30 years ago, by the work of Tessier and other craniofacial surgeons. However, the need to correct the skeleton in the upper third of the face is not frequently diagnosed or treated in aesthetic facial surgery. Here, we report on the aesthetic correction of a protrusive forehead. A patient visited our hospital for aesthetic contouring with a prominent forehead. The anterior wall of the frontal sinus was removed with a craniotome via the bicoronal approach. After the excised bone was repositioned, it was fixed with a titanium mesh plate and screws. An electric burr was used to contour the supraorbital rim and frontal bone. Once the desired shape was achieved, the periosteum was replaced, and the wound was closed in layers. When performed properly, frontal sinus contouring could significantly improve the appearance in patients with a prominent forehead. Plastic surgeons must carefully evaluate patients with a prominent forehead for skeletal remodeling that involves the accurate and safe repositioning of the anterior wall of the frontal sinus.

Reconstruction of severe medial orbital wall fractures using titanium mesh plates by the pericaruncular approach

Medial orbital wall fractures can cause severe aesthetic and functional complications, if not treated properly. The aim of this study was to prospectively evaluate the use of titanium mesh plates inserted through the pericaruncular approach for the treatment of medial orbital wall fractures. Between 1 July 2010 and 1 January 2013, a total of 17 patients with large medial orbital wall defects were treated. All of the large bony defects were treated using titanium mesh plates inserted through the pericaruncular approach. All patients had anatomically correct orbital wall reconstruction as accessed by immediate postoperative computed tomography scan. One patient with large bony defects presented with diplopia after the primary procedure. Re-operation was needed for correction. After surgery, the diplopia was corrected. In all patients, postoperative morbidity was minimal and cosmetic results were excellent. Titanium mesh may be a valuable material for the reconstruction of severe medial orbital wall defects. Its advantages include excellent structural support, shorter operative time, and ease of being moulded into the desired shape. The pericaruncular approach may allow for or give direct access to the medial orbital wall and orbital apex without any cutaneous incision or disruption of the medial canthal ligament, and insertion of titanium mesh plates is possible under direct vision. It is proposed that this technique could be advantageous in the reconstruction of severe medial orbital wall fractures.

Study on the Photo-Electro-Catalytic Oxidation of Methane

Emission control of methane from landfills has received considerable attentions in recent years. Photo-electro-catalytic oxidation of methane was carried out at the mode of continuous electrolysis and intermittent illumination with TiO2-coated titanium mesh plate as pholocatalyst and electrode in combination with ionic liquid as electrolyte under UV light irradiation. The result showed that the rapid conversion of methane was achieved under ambient pressure and temperature through photocatalytic oxidation combining with electrolysis. Under the mode of intermittent illumination (on:off = 10 min : 10 min) and continuous electrolysis (II-CE), the highest oxidation rate of methane (280 mg/(m3min)) was obtained. Under fixed off time and total illumination time, the oxidation quantity of methane linearly increased with the intermittent frequency. Photo-electro-catalytic oxidation of methane can be described by the first-order kinetics, and the apparent kinetic constant increased with the intermittent frequency.

Exposed Titanium Mesh and Dura Persisting for 8 Years After Cranioplasty

Cranial defects and their reconstructions may be challenging in neurosurgery and plastic surgery practice. In this article, we present a patient who had an infection on the scalp with exposed titanium mesh and dura for 3 months. The patient had undergone craniectomy and cranioplasty with titanium mesh plate with local scalp flap 8 years ago due to skin tumor invasion to the skull. After the titanium mesh was removed at the operation, a considerably wide osteoneogenesis and a small bone defect (1.5 × 2 cm in size) were detected under the titanium mesh plate (10 × 10 cm in size), and computed tomography substantiated our observations. On the basis of our observation, titanium mesh plates could be recommended in patients who need cranioplasty instead of materials that are occupying and inhibiting osteoneogenesis in cranioplasty applications.

Fascial sling technique for dural reconstruction after translabyrinthine resection of acoustic neuroma: technical note

Reconstruction of presigmoid dural defects after resection of acoustic neuromas via the translabyrinthine approach is paramount to prevent postoperative CSF leakage. However, primary dural reapproximation and achieving a watertight closure of the dural defect in this anatomical region are quite difficult. Standard closure techniques after the translabyrinthine approach often involve packing an abdominal fat graft that plugs the dural defect and mastoidectomy cavity. This technique, however, may pose the risk of direct compression of the fat graft on the facial nerve and brainstem. Nonetheless, even with the evolution in dural repair techniques, postoperative CSF leaks can still occur and provide a route for infection and meningitis. In this report, the authors describe a novel dural "sling" reconstruction technique using autologous fascia lata to repair presigmoid dural defects created after translabyrinthine resection of acoustic neuromas. The fascia lata is sewn to the edges of the presigmoid dural defect to create a sling to suspend the fat graft within the mastoidectomy defect. A titanium mesh plate embedded in porous polyethylene is secured over the mastoidectomy defect to apply pressure to the fat graft. In the authors' experience, this has been a successful technique for dural reconstruction after translabyrinthine removal of acoustic neuromas to prevent postoperative CSF leakage. There were no cases of CSF leakage in the first 8 patients treated using this technique. The operative details and preliminary results of this technique are presented.

Scleral Perforation Complicating Titanium Mesh Plaque in Orbital Blowout Fracture

A 27-year-old man who underwent a previous reconstruction surgery for left orbital blowout fracture and recent revision surgery for left cicatricial ectropion was admitted to the ophthalmology outpatient clinic with a 20-mm irregular conjunctival and scleral incision in the left eye at the 6-o'clock position. The scleral and conjunctival incisions were repaired, and during the operation, the anterior end of the titanium mesh plate was visible at the inferior orbital rim. The plastic surgery team removed the irritating end of the plate. Obvious adherence of periocular tissues onto the titanium implant and fibrovascular ingrowth through the implant were seen during this operation. The possible mechanism for the misdirection of the anterior end of the implant might be explained by iatrogenic rotation during the revision of the cicatricial ectropion. To the best of our knowledge, this is the first reported case demonstrating scleral incision caused by an orbital titanium implant.

Clinical application of solid physical orbital models and 3-dimmension pre-bent titanium implants for orbital fractures

Objective To evaluate the clinical application of solid physical orbital models and 3-Dimmension pre-bent titanium implants for orbital fractures.Methods 12 patients with orbital fractures were enrolled.First,virtual models were created based on the CT datasets.Next,the virtual model data were converted to the rapid prototyping machine to creat the solid physical models.Then the models were used as templates to cut and shape the titanium mesh plates in 3 dimensions.The 3-Dimmension pre-bent titanium mesh plates were implanted for surgical repair of the orbital fracture.Results Post-operatively,diplopia had been completely eliminated in 9 cases,except that extreme peripheral diplopia remained in 3 cases.Exophthalmometric measurements were approximately equal to each specific patient in the group.The outcome of orbital reconstruction using the pre-bent titanium meshes was favorable.Conclusion Solid physical orbital models and 3-Dimmension pre-bent titanium implants would lead to more predictive preoperative plan and more individualized reconstruction,would omit redundant trials for reshaping and refitting,would help to achieve more favorable surgical repair. Key words: Fractures,orbit; Reconstruction,surgical; Titanium mesh plates; Solid physical orbital models; Computer models; Computer-aided design; Computer-aided manufacture

Numerical Investigation on the Process of Multi-Point Holder Forming for Titanium Mesh Sheet

Multi-point holder forming (MPHF) adopts series of coupled holder punches, arranged between forming punches, to clamp the whole sheet in the forming zone. The multi-point holder forming processes of spherical parts of titanium mesh plate were simulated by finite element code, and the results were compared with those of multi-point die forming (MPDF). The influence of holder punch load on the deformation of spherical part in multi-point holder forming was investigated. The shape error analysis of titanium mesh formed by MPHF was performed in finial. The results showed that the spherical part had more excellent performance in multi-point holder forming, and the more deformation the titanium mesh was, the larger force of holder punch would be needed. In addition, there was a small shape error for titanium mesh part formed by MPHF before springback.

Evaluation of Three Cases Using a Novel Titanium Mesh System—Skull-Fit®with Orbital Wall (Skull-Fit WOW®)—For Cranial Base Reconstructions

Cranial base reconstructions associated with tumor resections around the orbital wall often require that both the upper and lateral orbital walls be reconstructed during a single procedure. Previously, we used titanium mesh plates that were preoperatively fabricated based on three-dimensional models. Although these plates are precise and do not increase the probability of infection, we still had to use autologous bones to reconstruct the orbital walls. Recently, we developed a new titanium mesh plate-called Skull-Fit(®)-with orbital wall (Skull-Fit WOW(®)), enabling us to reconstruct the cranial base and orbital walls without bone grafts. Here, we report on three reconstruction cases in which the novel titanium mesh-orbital wall system was used. In all three cases, the customized titanium mesh system performed satisfactorily with little, if any, complications.

Anterior corpectomy and reconstruction with titanium mesh cage and dynamic cervical plate for cervical spondylotic myelopathy in elderly osteoporosis patients

This retrospective study was to evaluate the relationship between osteoporosis and dynamic cervical plates in screw-plate or screw-bone interface of elderly cervical spondylotic myelopathy (CSM) patients. Retrospective study was conducted on elderly CSM patients, treated by anterior corpectomy and reconstruction with titanium mesh cages (TMC) and dynamic cervical plate between July 2004 and June 2007. All patients underwent bone mineral density (BMD) assessment in preoperation, and according to the osteoporosis degree they have been divided into two groups: moderate osteoporosis degree group and severe osteoporosis degree group. The clinical outcome [Japanese Orthopaedic Association score (JOA) and Visual Analogue Scale (VAS)], bone fusion assessment (CT mielogram), the change of titanium mesh cages and plate of cephalic screw-plate-angle (SPA) and cephalic endplate-plate-angle (EPA) of plain X-ray films were measured. The mean JOA score and recovery rate were not different between the two groups (P > 0.05). There was no loss of sagittal alignment after surgery in any patient, and no significant difference between both groups on lordosis measurements (P > 0.05). Although there was a significant difference of the cage subsidence rate between the two groups (P < 0.001), all patients had favorable bone union and none required additional treatment. The average changes of SPA were greater in A group patients than in B group patients, while the variation of EPA was higher in B group patients than in A group patients (P < 0.001). Despite the fact that there is a significant difference of the cage subsidence rate between the two groups no clinical outcome, nor sagittal alignment or fusion rate differences among groups was observed in elderly CSM patients.

Reconstruction orbitaire post-traumatique par grilles en titane préformées versus non préformées

We compared, clinically and radiologically, the accuracy and reliability of two types of titanium mesh plates used for orbital reconstruction. The first were non-preshaped mesh plates (NPMP) and the second were three-dimensionally preformed mesh plates (PMP). Two groups were created, each including 15 patients treated with NPMP and the second formed by 15 patients treated with PMP. The volume of each orbit was computed from coronal CT-scans using the OsiriX medical imaging software (version 3.3.2, www.osirix-viewer.com). Measurements were done for both, healthy and reconstructed sides. The other studied parameters were: sex, age, fracture distribution, and complications (diplopia and enophthalmia). The orbital volume difference between the reconstructed and the healthy contralateral side was not statistically significant in either group (NPMP: p=0.991 PMP: p=0.200). The mean orbital volume of reconstructed orbits was not statistically significant in either group (NPMP: 21.76 cm(3) and PMP: 20.28 cm(3), p=0.441). There is no difference in orbital volume reconstructions measured by the OsiriX software between non-preshaped and three-dimensionally preformed titanium mesh plates.

Reconstruction of Severe Medial Orbital Wall Fractures Using Titanium Mesh Plates Placed Using Transcaruncular-Transconjunctival Approach: A Successful Combination of 2 Techniques

To prospectively evaluate the use of titanium mesh plates in a combined transcaruncular-transconjunctival approach for severe medial orbital wall fractures. We analyzed the clinical and radiologic data of 10 patients with isolated blow-out orbital fractures. The fracture location was the medial wall in 5 (50%) and the floor/medial wall in 5 (50%). Of the 10 patients, 8 (80%) were treated using 3-dimensionally preformed orbital titanium mesh plates and 2 (20%) with nonpreformed radial orbital mesh plates fixed at the inferior orbital rim with 1 or 2 monocortical screws (diameter 1.3 mm). All the patients had satisfactory and anatomically correct orbital wall reconstruction as assessed on the immediate postoperative computed tomography scan. None of the patients experienced ophthalmic complications related to the transcaruncular-transconjunctival approach or developed enophthalmos as determined using Hertel exophthalmometry. One patient (10%) developed a nonhandicapping diplopia related to post-traumatic muscular contusion of the medial rectus muscle. The present study has demonstrated that titanium mesh plates placed using a combined transcaruncular-transconjunctival approach for the reconstruction of severe medial orbital wall fractures results in a high rate of success.

Repair of Sternal Dehiscence with Titanium Mesh Plates: The Sandwich Technique

Sternal dehiscence after cardiac surgery occurs infrequently and can lead to mediastinitis and prolonged hospital stay and may even result in death. The most common treatment for mechanical sternal instability is rewiring with wound debridement. We present a case in which a modified titanium mesh plate fixation technique was used. A safe and easy to perform technique, this method can be an alternative option to wire closure in a sternum with fractures, instability or poor bone quality.

A Case with Temporal Bone Ewing’s Sarcoma

Ewing’s sarcoma, a malignant primary bone tumor typically occurring within the pediatric or adolescent extremities or pelvis, is extremely rare in its primary cranial form. Recent immunohistochemical, molecular, and genetic studies have characterized Ewing’s sarcoma lineage as a primitive neuroectodermal tumor (PNET). We report a case of primary temporal bone Ewing’s sarcoma. A 19-year-old woman admitted with left temporal swelling was found in open biopsy to have Ewing’s sarcoma as confirmed by immunohistochemistry. The tumor was surgically removed and the wide surgical temporal bone defect was successfully reconstructed with a titanium mesh plate and an anterolateral thigh flap. The woman then underwent chemotherapy. Neither local recurrence nor distant metastasis has been seen in the 32 months since surgery. Adequate surgical resection and chemotherapy are thus vital in managing temporal bone Ewing’s sarcoma. Titanium mesh plates are also useful in reconstructing defect in surgical malignant tumor treatment.

Orbital Floor Fractures: A Retrospective Review of 45 Cases at a Tertiary Health Care Center

The purpose of this retrospective study was to investigate treatment options for orbital floor fractures at a Level 1 Trauma Center in Southern California. A review of 45 cases of isolated orbital floor fractures treated at the University of California at Irvine between February 2004 and April 2007 was done. Patients were retrospectively analyzed for gender, age, mechanism of injury, associated facial injuries, presenting symptoms, method of treatment, and postoperative complications. Thirty-six male patients and nine female patients were treated. Motor vehicle collision (26/45) was the most common cause of injury, and the mean age of the patients was 35.5 years (range: 15-81 years). Ecchymosis surrounding the orbital tissue was the most common presentation (38/45). Diplopia was present in 8 of 45 patients, with 1 patient requiring urgent decompression for retrobulbar hematoma. Forty-three patients underwent surgical repair; 40 underwent transconjunctival approach with lateral canthotomy; 17 underwent reconstruction with porous polyethylene Medpor (Porex Surgical, Inc., College Park, GA.); and 26 underwent reconstruction with a titanium mesh plate. Immediate postoperative complications included 12 patients with infraorbital numbness, 3 with diplopia, 1 with cellulitis, and 1 with ectropion with a subcilliary approach. Average timing of surgery of our study was 4.94 days (range, 1-20 days). Orbital floor fracture management has changed significantly over the past few decades with the introduction of new internal fixation methods and new materials for reconstructing orbital floor defects. Recommendations for surgical intervention on orbital floor fractures mostly depend on clinical examination and imaging studies. Consequences of inadequate repair of orbital floor fractures can lead to significant facial asymmetry and visual problems. Both porous polyethylene and titanium plates are effective tools for reconstructing the orbital floor. Our review demonstrates that orbital floor fractures can be repaired safely with minimal postoperative complications and confirms that transconjunctival approach to orbital floor is an effective way for exposure and prevention of ectropion that can be seen with other techniques.

Computer-Aided Volumetric Comparison of Reconstructed Orbits for Blow-Out Fractures With Nonpreformed Versus 3-Dimensionally Preformed Titanium Mesh Plates

To compare and evaluate, using computer-aided volumetric measurements, the accuracy and reliability of nonpreformed mesh plates (NPMPs) versus 3-dimensionally preformed titanium mesh plates (PMPs) in posttraumatic orbital volume restoration. Facial coronal computed tomographic scan slices from 20 patients (10 in the NPMP and 10 in the PMP group) were used to measure bony orbital volume using OsiriX Medical Image software (version 3.3.2, www.osirix-viewer.com). The procedure was performed on both orbits; thereafter, the volume of the contralateral health orbit was used as a control for comparison in the 2 groups of patients. The difference in orbital volume between the 2 groups and between the reconstructed versus uninjured side in both groups have been statistically correlated. The mean orbital volume between the reconstructed (19.215 mL in NPMP and 21.791 mL in PMP) and the contralateral uninjured side (18.955 mL in NPMP and 21.710 mL in PMP) was not statistically significant (P > 0.05). The mean orbital volumes of the reconstructed orbits were 19.215 mL in the NPMP and 21.791 mL in the PMP group, with no statistically significant difference (P > 0.05). The volume data of the reconstructed orbit fitted that of the contralateral uninjured orbit with an accuracy of a maximum of 1.85 mL in the NPMP group and 2.5 mL in the PMP group. The current study demonstrated that there were no significant differences in the orbital volume restoration using either technique. In fact, both techniques allow for close reproduction of natural orbital volume and shape, and its use in posttraumatic orbital wall reconstruction was successful.

A finite element analysis of comparision study on mechanical changes in cage-endplate interface between titanium mesh cages with or without augmentation of internal end ring system after anterior cervical corpectomy

Objective To study the mechanical changes in cage-endplate interface between titanium mesh cages with or without augmentation of internal end ring system after anterior cervical corpectomy by finite element analysis. Methods Based on the intact finite element model (FE/Intact) ,two models were generated by simulating anterior cervical titanium mesh fusion cage and plate after C5 corpectomy according to the applied titanium mesh cage conditions ;? 10 mm titanium mesh cage without internal end ring (S-) and ?10 mm titanium mesh cage with internal end ring (S + ). von Mises stress of seven parts on the superior and inferior cage-endplate interface was comparatively analyzed between model with S-and model with S + after loading of each model being simulated using multidirectional moment loads of 1.8 Nm combined with a compressive preload of 80 N in compression, flexion and extension. Results The stress on the superior (7.61,8.23,9.97) Mpa and inferior cage-endplate interface (5.43,5.74,6.88) Mpa in the model with S-was bigger than that (10.65,11. 59,14. 27 and 7.46,8. 12,10.04) Mpa in the model with S + under the three loading conditions. Conclusion A titanium mesh cage with internal end ring produces a significant decrease of the cage-endplate interface stress and lower incidence of titamium mesh cage subsidence after anterior cervical corpectomy. Key words: Cervical spine; Corpectomy; Endplate; Titanium mesh cage

Accuracy and Predictability in Use of AO Three-Dimensionally Preformed Titanium Mesh Plates for Posttraumatic Orbital Reconstruction

The aim of this study was to prospectively evaluate the accuracy and predictability of new three-dimensionally preformed AO titanium mesh plates for posttraumatic orbital wall reconstruction.We analyzed the preoperative and postoperative clinical and radiologic data of 10 patients with isolated blow-out orbital fractures. Fracture locations were as follows: floor (N = 7; 70%), medial wall (N = 1; 1%), and floor/medial wall (N = 2; 2%). The floor fractures were exposed by a standard transconjunctival approach, whereas a combined transcaruncular transconjunctival approach was used in patients with medial wall fractures. A three-dimensional preformed AO titanium mesh plate (0.4 mm in thickness) was selected according to the size of the defect previously measured on the preoperative computed tomographic (CT) scan examination and fixed at the inferior orbital rim with 1 or 2 screws. The accuracy of plate positioning of the reconstructed orbit was assessed on the postoperative CT scan. Coronal CT scan slices were used to measure bony orbital volume using OsiriX Medical Image software. Reconstructed versus uninjured orbital volume were statistically correlated.Nine patients (90%) had a successful treatment outcome without complications. One patient (10%) developed a mechanical limitation of upward gaze with a resulting handicapping diplopia requiring hardware removal. Postoperative orbital CT scan showed an anatomic three-dimensional placement of the orbital mesh plates in all of the patients. Volume data of the reconstructed orbit fitted that of the contralateral uninjured orbit with accuracy to within 2.5 cm(3). There was no significant difference in volume between the reconstructed and uninjured orbits.This preliminary study has demonstrated that three-dimensionally preformed AO titanium mesh plates for posttraumatic orbital wall reconstruction results in (1) a high rate of success with an acceptable rate of major clinical complications (10%) and (2) an anatomic restoration of the bony orbital contour and volume that closely approximates that of the contralateral uninjured orbit.