Use Of Bone Wax Research Articles

Use of bone wax as a template for intraoperative evaluation of facial defects and shaping of polyethylene implants: Mavili E, Akyürek M. Plast Reconstr Surg 100:1247, 1997

Use of bone wax as a template for intraoperative evaluation of facial defects and shaping of polyethylene implants: Mavili E, Akyürek M. Plast Reconstr Surg 100:1247, 1997

Use of bone wax as a template for intraoperative evaluation of facial defects and shaping of polyethylene implants.

With the advent of polymer chemistry, an increasing number of alloplastic materials are now available for use as onlay implants for reconstruction of facial bony and soft-tissue deformities. An optimal clinical result of a facial contour deformity surgery will depend not only on the choice of implant, but also on the method of giving exact shape to the implant to be used. The latter is particularly important to fit the implant into the complex configuration of a specific defect of bone and soft tissue. A template greatly enhances the accuracy of implant design. In this paper we describe a new method of fabricating polyethylene implants by using bone wax as an intraoperative template. We used this technique in four patients aged 8 to 35 years (average, 18 years) with posttraumatic and congenital facial defects without any complications. We present this method as a simple, inexpensive, and accurate alternative to the more sophisticated, but expensive and time-consuming, computer-assisted implant generation.

Mastoid Canal and Migrated Bone Wax in the Sigmoid Sinus

A STUDY OF the migration of bone wax into the sigmoid sinus through the mastoid canal is reported here. In 7 of 161 patients who underwent retromastoid craniectomy, the postoperative soft tissue window image computed tomographic scans demonstrated a hypodense mass in the ipsilateral sigmoid sinus. The density value of the hypodense mass ranged from −34 to −79 Hounsfield units, which was neither as low as that of air nor as high as that of cerebrospinal fluid, but was comparable to that of fat tissue or bone wax. The continued presence of all of these masses in the sigmoid sinus was confirmed 1 month to 2 years after surgery. These computed tomographic findings suggested that this abnormal hypodense mass might be a migrated fragment of the bone wax that had been used for the control of venous bleeding from the mastoid emissary vein, because each of the seven affected patients had a large mastoid foramen and a large quantity of bone wax had been needed to control the bleeding during retromastoid craniectomy. No other material with the potential to migrate into the sigmoid sinus had been applied as a packing material. In two of the seven patients, venous magnetic resonance angiography after surgery demonstrated that the ipsilateral sigmoid sinus was not patent and the computed tomographic scans also revealed that the hypodense masses occupied the sigmoid sinus. It is concluded that the intrasurgical application of a large quantity of bone wax to control the bleeding from the large emissary veins carries a risk of the migration of bone wax into the sigmoid sinus. Care should be taken in the management of the emissary veins, and the use of bone wax should be minimized in order to prevent sigmoid sinus occlusion.

Osseous regeneration in the presence of four common hemostatic agents

The iliac crest is a common site for bone procurement in oral and maxillofacial surgery. The goal of this study was to evaluate the potential for bone regeneration in the presence of four common hemostatic agents in a manner that parallels iliac bone procurement in humans. The agents evaluated were 1) Avitene (microfibrillar collagen; Medchem Products, Inc, Woburn, MA); 2) bone wax (beeswax with isopropyl palmitate; Ethicon, Inc, Somerville, NJ); 3) Gelfoam (absorbable gelatin sponge; The Upjohn Company, Kalamazoo, MI); and 4) Surgical (oxidized regenerated cellulose; Johnson & Johnson Products, Inc, Patient Care Division, New Brunswick, NJ). Five surgical defects in each of four dogs were created for placement of the four materials; one defect served as an empty control site. The dogs were then allowed to heal over a 2-month period. Radiographic and histologic examination showed new bone formation in the presence of Avitene, Surgicel, and Gelfoam. Residual material incorporated in bone, without foreign-body response, was noted in the Avitene and Gelfoam sites. Bone wax, however, showed an intense foreign-body reaction, characterized by giant cells, plasma cells, fibrous granulation tissue, and lack of bone reformation. On the basis of these initial findings, it was concluded that Surgicel, Avitene, and Gelfoam may be adequate hemostatic agents for use in iliac bone procurement, whereas the use of bone wax appears to be contraindicated.

Bonewax as a mould in the reconstruction of eye socket

The use of Bonewax as an alternative for moulding purposes in the reconstruction of the eye socket with a mucosal graft is presented. The fact that it can easily be shaped peroperatively and can adapt effectively even into the smallest corners of the orbital cavity, has improved the graft take, maintaining a sufficient eye socket without causing any significant reaction, has proved that it may be considered as a good method in such cases.

The promotional effect of bone wax on experimental Staphylococcus aureus osteomyelitis

The consequences of using surgical bone wax are not well studied. We evaluated the infection-promoting potential of sterile bone wax in a rat model of chronic Staphylococcus aureus osteomyelitis. The addition of bone wax greatly reduced the quantitative bacterial inoculum (log colony-forming units) required to establish chronic osteomyelitis in 50% and 100% of challenged animals. The 50% infection rate was reduced from log 6.9 to 2.6 and the 100% infection rate from 8.2 to 4.4, respectively (p less than 0.015, t test for parallelism). Separate experiments were done 10 to 30 minutes after inoculation with only log 6.4 staphylococci. Tibiae of animals that received bone wax yielded more organisms than those that did not (log 2.76 +/- 0.68 versus 1.72 +/- 0.94, p less than 0.01). At 24 hours quantitative colony counts were not significantly different whether animals received wax or not (log 5.02 +/- 0.42 versus 4.43 +/- 0.65, p greater than 0.09). These studies suggest that the routine surgical use of bone wax should be reassessed.

The state of the frontal sinus after craniotomy.

In 39 patients, 24 male, 15 female, the frontal sinus was opened during a frontal, a bifrontal or a pterional trephination for neurosurgical treatment of trauma, tumours or aneurysms. In 25 out of 39 patients the frontal sinus subsequently was obliterated, in 11 out of 39 patients the apical half or 2/3 of the sinus were ablated and the remaining caudal part covered with a galea periosteal flap leaving the fronto-nasal duct intact. In 3 out of 39 patients, the periphery of the sinus was ablated and the remaining part covered. All patients were followed over a mean period of 2 years and had a final evaluation using CTs, X-rays, ultrasonography and a complete ENT examination. In 4 out of 25 obliteration was successful and complete, in 16 out of 25 there was a partial or complete re-aeration of the residual sinus and in 5 out of 25 the sinus was infected. In one out of eleven patients where the frontal sinus was bisected with preservation of the lower half, the basal part of the sinus was infected, in 10 out of 11 the residual sinus was aerated and draining well. In one out of three patients where the periphery of the sinus was ablated, there was infection, two of three sinuses were aerated. Evaluating the experience in these 39 patients and our recent experience, obliteration of the sinus with muscle is very unreliable and the use of bone wax is obsolete. Covering a bisected or peripherally opened sinus with fascia or a galea periosteal flap will yield a well aerated and draining sinus, provided the naso-frontal duct is intact.

The Embolization of Bone Wax from Sternotomy Incisions

We discuss our study on the effects of discontinuation of the usage of bone wax as a hemostatic agent in sternotomy incisions. In 1976, we abandoned use of bone wax because it was suspected of causing several cases of Mycobacterium fortuitum sternal osteomyelitis. In a retrospective study involving 400 patients, we found that this step did not increase postoperative bleeding as measured by drainage from the chest tube and by the need to return patients to the operating room because of bleeding. It also was observed that there was an appreciable simultaneous drop in pulmonary complications. To test our theory that the wax pressed into the bone marrow can embolize to the lung, radioactively tagged bone wax was pressed into the cut sternum in animal models, and a search was made for radioactive deposits in the peripheral lung tissue. Shortly after the application of the wax, there was evidence of large radioactive deposits in the lungs. It is probable that this embolization occurs also under clinical conditions and may play a role in pulmonary complications following open-heart operations.

The use of bone wax to facilitate retrograde filling techniques.

The use of bone wax to facilitate retrograde filling techniques.