A study of patients with large cranial defects involving the frontal bone, frontal sinus, nose, and orbit does not support the contention that there is a clear superiority of reconstructive material despite a history of previous bone infection. No patient with an isolated cranial reconstruction experienced an infection despite location in the area of the frontal sinus or the use of acrylic material. All patients experiencing infection underwent simultaneous reconstruction of the frontal cranium and nose and three-or four-wall reconstruction of the orbit, where the frontal sinus had previously been eliminated and where a previous bone infection had been present. Risk factors associated with cranioplasty were timing (p = 0.001) and cranial vault reconstruction in communication with previously infected ethmoid sinuses and the nose (p = 0.03). A history of previous bone infection suggests increased risk (p = 0.15). The choice of reconstructive material was not significant, although acrylic cranioplasties did not experience the complications expected from a review of the literature. The times have been that, when the brains were out, the man would die, and there and end; but now, they rise again.
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