TY - JOUR
T1 - Craniofacial reconstruction with poly(methyl methacrylate) customized cranial implants
AU - Huang, Gary J.
AU - Zhong, Susan
AU - Susarla, Srinivas M.
AU - Swanson, Edward W.
AU - Huang, Judy
AU - Gordon, Chad R.
N1 - Publisher Copyright:
Copyright © 2014 by Mutaz B. Habal, MD.
PY - 2015/1/21
Y1 - 2015/1/21
N2 - Background: Secondary cranioplasty with customized craniofacial implants (CCIs) are often used to restore cerebral protection and reverse syndromes of the trephined, and for reconstruction of acquired cranial deformities. The 2 most widely used implant materials are polyetheretherketone and poly(methylmethacrylate) (PMMA). Previous series with CCIs report several major complications, including implant infection leading to removal, extended hospital stays, and surgical revisions. With this in mind, we chose to review our large case series of 22 consecutive PMMA CCI cranioplasties treated by a single craniofacial surgeon. Methods: A cohort of 20 consecutive patients receiving 22 PMMA implants during a 2-year period was identified and outcomes reviewed. The mechanism of initial insult, time from craniectomy to cranioplasty, anesthesia time, major and minor postoperative complications, radiation history, and length of follow-up were statistically analyzed. Results: There were no complications related to infection, hematoma/seroma, or cerebrospinal fluid leak (0/22, 0%). Two patients experienced major complications related to persistent temporal hollowing (PTH) following standard CCI cranioplasty, which required revision surgery with modified implants (2/22, 9%). One minor complication of self-resolving transient diplopia was noted (1/22, 5%). Conclusions: In this consecutive series, PMMA CCIs were associated with a very low complication rate, suggesting that PMMA may be a preferred material for CCI fabrication. However, with 10% (2/20) of patients experiencing PTH and dissatisfaction related to asymmetry, future research must be directed at modifying CCI shape, to address the overlying soft-tissue deformity. If successful, this may increase patient satisfaction, prevent PTH, and avoid additional costs of revision surgery.
AB - Background: Secondary cranioplasty with customized craniofacial implants (CCIs) are often used to restore cerebral protection and reverse syndromes of the trephined, and for reconstruction of acquired cranial deformities. The 2 most widely used implant materials are polyetheretherketone and poly(methylmethacrylate) (PMMA). Previous series with CCIs report several major complications, including implant infection leading to removal, extended hospital stays, and surgical revisions. With this in mind, we chose to review our large case series of 22 consecutive PMMA CCI cranioplasties treated by a single craniofacial surgeon. Methods: A cohort of 20 consecutive patients receiving 22 PMMA implants during a 2-year period was identified and outcomes reviewed. The mechanism of initial insult, time from craniectomy to cranioplasty, anesthesia time, major and minor postoperative complications, radiation history, and length of follow-up were statistically analyzed. Results: There were no complications related to infection, hematoma/seroma, or cerebrospinal fluid leak (0/22, 0%). Two patients experienced major complications related to persistent temporal hollowing (PTH) following standard CCI cranioplasty, which required revision surgery with modified implants (2/22, 9%). One minor complication of self-resolving transient diplopia was noted (1/22, 5%). Conclusions: In this consecutive series, PMMA CCIs were associated with a very low complication rate, suggesting that PMMA may be a preferred material for CCI fabrication. However, with 10% (2/20) of patients experiencing PTH and dissatisfaction related to asymmetry, future research must be directed at modifying CCI shape, to address the overlying soft-tissue deformity. If successful, this may increase patient satisfaction, prevent PTH, and avoid additional costs of revision surgery.
KW - Craniofacial reconstruction
KW - Cranioplasty
KW - Customized cranial implant
KW - PMMA
KW - Poly(methylmethacrylate) (PMMA)
KW - Polyetheretherketone (PEEK)
KW - Skull defect
KW - Temporal hollowing
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U2 - 10.1097/SCS.0000000000001315
DO - 10.1097/SCS.0000000000001315
M3 - Article
C2 - 25376145
AN - SCOPUS:84921439144
SN - 1049-2275
VL - 26
SP - 64
EP - 70
JO - Journal of Craniofacial Surgery
JF - Journal of Craniofacial Surgery
IS - 1
ER -