Skull osteohypertrophy as a complication of bone wax

Kamide, Tomoya; Nakada, Mitsutoshi; Hirota, Y; Hayashi, Yutaka; Hayashi, Yasuhiko; Uchiyama, Naoyuki; Hamada, Jun-ichiro

doi:10.1016/j.jocn.2009.03.014

Cited by 19 publications

(9 citation statements)

References 9 publications

(18 reference statements)

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“…The bone mineral density (BD) too was significantly low compared to that of the control and surgicel filled defects [Tables 1 and 3]. This is supported by numerous animal and clinical studies16171819 which have demonstrated that the bone wax remains at the implantation site indefinitely and inhibits new bone formation.…”

Section: Discussionmentioning

confidence: 87%

The effects of surgicel and bone wax hemostatic agents on bone healing: An experimental study

Nooh

Abdullah

Grawish

et al. 2014

IJOO

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Background:The biological effects of hemostatic agends on the physiological healing process need to be tested. The aim of this study was to assess the effects of oxidized cellulose (surgicel) and bone wax on bone healing in goats’ feet.Materials and Methods:Three congruent circular bone defects were created on the lateral aspects of the right and left metacarpal bones of ten goats. One defect was left unfilled and acted as a control; the remaining two defects were filled with bone wax and surgicel respectively. The 10 animals were divided into two groups of 5 animals each, to be sacrificed at the 3rd and 5th week postoperatively. Histological analysis assessing quality of bone formed and micro-computed tomography (MCT) measuring the quantities of bone volume (BV) and bone density (BD) were performed. The results of MCT analysis pertaining to BV and BD were statistically analyzed using two-way analysis of variance (ANOVA) and posthoc least significant difference tests.Results:Histological analysis at 3 weeks showed granulation tissue with new bone formation in the control defects, active bone formation only at the borders for surgicel filled defects and fibrous encapsulation with foreign body reaction in the bone wax filled defects. At 5 weeks, the control and surgicel filled defects showed greater bone formation; however the control defects had the greatest amount of new bone. Bone wax filled defects showed very little bone formation. The two-way ANOVA for MCT results showed significant differences for BV and BD between the different hemostatic agents during the two examination periods.Conclusion:Surgicel has superiority over bone wax in terms of osseous healing. Bone wax significantly hinders osteogenesis and induces inflammation.

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Section: Discussionmentioning

confidence: 87%

The effects of surgicel and bone wax hemostatic agents on bone healing: An experimental study

Nooh

Abdullah

Grawish

et al. 2014

IJOO

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“…Bone wax is a mixture of sterile beeswax (70%) and Vaseline (30%), which is routinely used in neurosurgery, craniofacial surgery, orthopedics, thoracic surgery [2], and sometimes orbital surgery to reduce bleeding and to seal bony window defects. Several complications have been reported to be associated with the use of bone wax, such as infection, osteohypertrophy, pain, granuloma formation, allergic reactions, and thrombosis [1, 3, 4]. Rare complications, such as ptosis and diplopia, were reported in a recent case of craniotomy [5].…”

Section: Discussionmentioning

confidence: 99%

Bone wax migrates to the orbit in a patient with a frontal sinus abnormality: a case report

Zhou

Wei

et al. 2019

BMC Ophthalmol

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BackgroundBone wax is the most widely used hemostatic bone sealant because of its availability, ease of use, immediate action, and minimal adverse effects. Several complications have been reported to be associated with the use of bone wax, such as infection, osteohypertrophy, pain, granuloma formation, allergic reaction, and thrombosis. Here, we present a rare complication, namely, bone wax migration, which developed after a craniotomy on a patient who had a frontal sinus abnormality.Case presentationA 51-year-old woman complained of pain and swelling in her left eye accompanied by difficulty opening the left eyelid after undergoing a craniotomy. An examination revealed left eye proptosis with ptosis, eyelid swelling, and increases in intraorbital pressure and intraocular pressure (IOP). According to a CT and an MRI of the orbit, we found that the intraoperative bone wax had migrated to the orbit, thereby causing compression. We also found that the basal frontal sinus of the patient was congenitally defective, which may have induced the migration of the bone wax. Given that the patient recently underwent a craniotomy and given the risks associated with orbital surgery, she refused to undergo a surgery to remove the bone wax. Thus, the patient was administered mannitol intravenously daily, accompanied by topical Timolol, to reduce the intraorbital pressure and IOP. This treatment led to a gradual decrease in IOP and intraorbital pressure, and these parameters remained stable after treatment ended. During the 6-month follow-up, the best corrected visual acuity improved, and ptosis and restricted eye movements also improved significantly.ConclusionsWe report a case of bone wax migration that developed after a craniotomy on a patient who had a congenital defect in the basal frontal sinus. Extra caution should be taken when using bone wax, and a comprehensive understanding of the patient’s intracranial anatomy is important for decreasing the incidence of bone wax migration. Additionally, when a patient presents with symptoms of ocular compression, bone wax migration should be considered in addition to typical radiological changes.

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“…Reported complications related to bone wax application are varied but uncommon. These include granulomatous reaction, 7-10 mass effect, 2 saphenous vein graft thrombosis, 11 epistaxis, 12 calvarial osteohypertrophy, 13 and infection. 14 Retained, excessive, or migrated bone wax might simulate a mass.…”

Section: Discussionmentioning

confidence: 99%