Classification of the Residual Cranial Defects and Selection of Reconstruction Materials

Abstract

The cranial defects are complex in nature and are due to various causes. Therefore, there is a need for a common term of reference to these defects. This requirement stood as a prime reason for proposing a classification system for cranial defects. The classification is based on 2 decades of experience in cranioplasty. This efficient and simple way of representation would fill the existing lacunae for a systematic communication on cranial defects. Over the ages the evolution of reconstruction and grafting had undergone a massive progress. Therefore, it is essential to enumerate all available graft and bio-materials for restoring the cranial defects. The aetiology for these defects, age and sex of the patient, site and size of the defect, associated systemic conditions, cost factor, and operator's choice are the factors that play key role in the selection of the reconstructive material. This article discusses on these factors in cranioplasty. High success rate with excellent function and cosmetic outcome in using a variety of materials, as shared in this article. The advantages of autografts cannot be matched by any existing alloplast. However, in case of larger defects, for a better cosmetic outcome and to reduce the donor site morbidity, alloplasts are the most widely preferred material of choice.

Reconstrucción de fractura de cráneo deprimida en pacientes escolares. Descripción de la técnica

“…Historically, depressed fractures and even more exposed ones undergo two procedures: the first one, an urgency where the surgical cleaning is performed, drainage of the associated hematomas and the involved bone segments, which are considered in many cases not viable and the second one the elective cranioplasty for the repair of the bone defect, dividing it in two surgical times to reduce the risk of infection in the surgical site. Nevertheless, we propose an alternative that has shown both safety and a single surgical procedure, unlike other authors who use this same principle of unique surgery with the use of alloplastic materials 4,5 which in our environment is difficult to use due to the cost. We use an alternative technique that in our experience is safe and offers results comparable to other materials with a lower cost.…”

Custom-made hydroxyapatite cranioplasty: Radiological and histological evidence of bone-biomaterial osteointegration in five patients

“…HA implants have demonstrated their ability to recolonize the bone in cranial and maxillofacial reconstruction. [12] Among alloplastic materials, macroporous hydroxyapatite is characterized by the presence of micro, macro, and interconnecting pores, mimicking the structure of the living bone.…”

Pediatric Cranial Defects: What Size Warrants Repair?

“…Although reports demonstrate the observance of spontaneous ossification in the young, authors vary in the length of time they recommend waiting before intervention. According to Sahoo et al 12 , the osteogenic potential of the cranium and dura of children under the age of 2 obviates the need for surgical repair of cranial defects. If persistent, cranioplasty should be deferred until 3 to 5 years of age.…”