Cranial bone reconstruction with customized implants after trauma

Abstract

Introduction: Cranial defects due to trauma are frequent. They are usually repaired in a secondary fashion due to features such as syndrome of the trephined, for brain protection and for cosmetic purposes. Historically, various materials have been used for reconstruction. Case reports: Five cases of patients reconstructed with customized polyetheretherketone (PEEK) o polymethyl methacrylate (PMMA) implants are presented. Defects involved the frontal bone, superior orbital rim and orbital roof in four cases, and the lateral area of the frontal bone, the temporoparietal area and the border of the occipital bone in one. In four patients, reconstruction took place between 6 and 12 months after the injury; in one patient, after 25 years. Two cases required tissue expansion before placing the implant. Results: Four patients evolved favorably, with improvement in neurologic symptoms and adequate shape and contour, plus adequate healing of the scalp flaps. One patient had an infection due to Staphylococcus aureus, attributed to a mucocele and fistula between the airway and the cranial cavity, leading to removal of the implant. Conclusions: Customized implants are a useful resource for cranial defects. They offer satisfactory results, both functional and cosmetic. Precautions should be taken in treating injuries that involve the frontal sinus, to ensure there is no communication between the airway and the cranial cavity.

Tissue Expanders in Staged Calvarial Reconstruction: A Systematic Review

“…Regarding type of calvarial implant used in the procedure, 10.7% of patients received an autologous implant, while 89.3% received an alloplastic implant. With respect to type of soft tissue coverage performed, 75.3% of patients received skin expansion only, 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 20% received additional scalp or pericranial flap coverage, 11 18 26 27 28 29 30 31 32 33 34 35 and 4.7% received additional skin grafting 31 33 to provide adequate skin coverage for the defect. Among those patients who received skin grafts, three patients (75%) received pericranial flap coverage as well.…”