Use of Calcium-Based Bone Cements in the Repair of Large, Full-Thickness Cranial Defects: A Caution (original) (raw)
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Journal of maxillofacial and oral surgery, 2015
Cranial defects may arise due to trauma, infection, surgical ablation or errors in development. Restoration of such defects is important for esthetics, function and morale of the patient. Several materials are available. Each has its advantages and disadvantages. Search is on for an ideal material. Autogenous grafts remain the gold standard in reconstruction of such defects. However, the morbidity associated with their harvest, additional time required, the need for a second surgical site and the limited supply has led to the search for newer substitutes. Although many materials are available today including biologic and non biologic substitutes, there is still no consensus about the best material. In this article we describe our use of calcium phosphate cements for reconstruction of hemispherical cranial defects. Cases requiring reconstruction of hemispherical cranial defects (more than 15 cm in any dimension) were selected for study. After exposing the defect under GA, titanium me...
Journal of Biomedical Materials Research Part A, 2006
Calcium phosphate (Ca-P) cement is a well established material for bone repair. The bone biological properties of Ca-P cement can even be further improved by creating porosity in the material. The current study aimed on the evaluation of the osteoconductive behavior of porous Ca-P cement. Therefore, circular defects (6, 9, and 15 mm in diameter) were created in the cranium of 3 months old rabbits and filled with porous Ca-P cement implants. The total porosity of implants was calculated to be 71, 74 and 74% respectively and the average pore diameter was 150 lm. In addition, empty control defects were prepared. After 12 weeks implantation time the animals were sacrificed and radiographic, histological, and histomorphometrical evaluation was performed. The Critical Size Defect (CSD) of this species at this location for an implantation time of 12 weeks was confirmed to be 15 mm.
Cranial Reconstruction Using Bioabsorbable Calcified Triglyceride Bone Cement
Journal of Craniofacial Surgery, 2010
Background: We report our experience on 6 cases of cranial reconstruction using bioabsorbable calcified triglyceride KRYPTO-NITE Bone Cement (Doctors Research Group). Methods: Six patients underwent cranial reconstruction during the surgical removal of a supratentorial tumor between September 2008 and November 2009 at our department. In 5 patients, we performed the cranial reconstruction using KRYPTONITE Bone Cement and cranial fixations; in the remaining patient, we avoided cranial fixation systems or other bone sutures to obtain good aesthetic results in the frontal supraorbital region. Preoperatively and 7 days and 12 months after surgery, patients were assessed using craniocerebral magnetic resonance imaging and computed tomography (CT). Results: We observed that this bone cement was an injectable liquid for up to 8 minutes after mixing, it became adhesive at 8 to 15 minutes, and it was then shaped for use. Brain and dural reconstructions were not protected when this bone cement was being poured into the craniotomy site because of the minimal exothermal reaction. After 8 minutes, additional expansion is limited to 10%; therefore, we took heightened awareness of the amount of cement needed to fill the bone defect. In all patients, postoperative craniocerebral CT scanning, at 7 days, showed perfect alignment of the craniotomical bone and optimal filling of bone defects. No complications occurred, and aesthetic result was good. Twelve months after surgery, craniocerebral CT scanning showed bioabsorbability and osteoconductivity of this cement. Conclusions: KRYPTONITE Bone Cement is a nonthermal conducting, radiopaque, nonmagnetic, lightweight, simple to prepare, and easily applicable and molded material. Moreover, it has adhesive, bioabsorbable, and osteoconductive properties. To our knowledge, we present the first case of cranial reconstruction using this cement without cranial fixation systems.
Journal of the Korean Association of Oral and Maxillofacial Surgeons, 2018
(J Korean Assoc Oral Maxillofac Surg 2018;44:207-211) Among different graft materials for craniofacial reconstruction, calcium phosphate cements have the advantages of alloplastic grafts and wide use. The authors report a case of foreign body reaction following frontal reconstruction with JectOS (an injectable calcium orthophosphate cement; Kasios) and reviewed the literature on complications of this material after craniofacial reconstruction from 2002 to 2017. Complications were categorized into two groups: immunologic reactions (consisting of seroma collection, chronic sinus mucosa swelling, and foreign body reaction) and non-immune events (infection, fragmentation, and ejection). It is wise to use calcium phosphate-based material only in selected cases with small defects, and long-term follow-up is needed to observe their consequences.
In Search of the Ideal Skull Reconstruction
Polish Journal of Surgery, 2008
In the early 1980s it was shown that bone from the skull, (membranous bone), maintained its volume to a significantly greater extent than bone from the rib and iliac crest regions, (endochondral bone). However, the reason for this enhanced volume maintenance was not clarified for many years. On the basis of this enhanced volume maintenance, cranial bone became the ideal autogenous graft of choice for hard tissue repair. In the ensuing years, the current authors performed a large number of autogenous split skull cranial bone cranioplasties with significant success. However, the lure of an off-the-shelf material that obviates bone harvest remained. From 1995 to 2005 the senior author performed twenty full-thickness skull defect cranioplasty corrections using calcium phosphate cement (Norian). Of these full-thickness defects, 16 were large (arbitrarily defined as greater than 25 cm 2). In this paper, we report our long-term major and minor complication rate using this material. Due to our high, long-term complication rate (38%), we believe this material is contraindicated for large, full-thickness, skull defects (greater than 25 cm 2) and we have returned to autogenous cranial bone as the gold standard for reconstruction of such patients.
Journal of Maxillofacial and Oral Surgery, 2010
A 40-years-old male patient reported to our department with a chief complaint of persistent palatal fluid discharge and large depressed forehead defect. He gave a history of trauma 20 months back due to head on collision to electric pole and underwent surgery twice for open reduction and fixation of facial skeletal fractures. After 9 months of surgery again a third surgery was performed for the removal of frontal bone due to infection and osteomyelitis at the same site. Extra-oral examination revealed a large fronto-cranial defect extending from superior border of frontal bone to supra-orbital margins bilaterally in length, and from frontal right lateral to frontal left lateral side in width, measuring 8.0 cm in length, 10.5 cm in width and 1.5 to 2.0 cm in depth. Intra-oral sinus fluid discharge was from left posterior palatal region. Preoperative CT was taken and reconstruction of fronto-cranial defect was successfully performed with bone cement. Alloplastic implant reconstruction achieved an excellent esthetic result without any complications.
Journal of Cranio-Maxillofacial Surgery, 2005
Introduction: Aim of this experimental study was to assess the suitability of a new brushite calcium phosphate cement (chronOStInject) for cranioplasty and to compare the results with a commercially available apatite calcium phosphate bone cement (Biobon s ). Material and methods: A bilateral full-size craniotomy defect (23 mm in diameter) was created in the parietal bones of 18 adult Swiss Alpine sheep and filled with either chronOStInject or Biobon s . The observation intervals were 2, 4 and 6 months. Macroscopical, radiological, histological and histomorphometrical evaluations were performed. Results: New bone formation was moderate and did not differ significantly between the biomaterials. Cement resorption occurred centripetally in the chronOStInject group and proceeded significantly faster than the degradation process of Biobon s . However, implantation of chronOStInject was associated with a significantly higher rate of fibrous tissue formation. Cement resorption was mediated by macrophages in the chronOStInject group, while osteoclasts were the predominant cell type involved in degradation of Biobon s . Osteoblasts were found adjacent to residual cement in both groups. Conclusion: chronOStInject demonstrated osteoconductive properties, good biocompatibility and superior bioresorbability but none of the cements proved suitable for filling large cranial bony defects due to the high rate of fibrous tissue formation and insufficient bony regeneration. r 2004 European Association for Cranio-Maxillofacial Surgery
Repair of craniofacial defects with hydroxyapatite cement
Journal of oral and maxillofacial …, 1997
Purpose: The objective of this study was to evaluate the course of healing of craniofacial bone defects when filled with hydroxyapatite cement and to determine whether adding various percentages by weight of demineralized bone powder to the cement will result in ...
Utility of bone cement for frontal bony contour deformity
Marmara Medical Journal, 1992
In our department, in 2 male patients having frontal bony depression due to motor vehicle accident "Methyl Methacrylate", known as Bone Cement was utilized to correct the contour deformity. In both cases, the cement was applied as onlay after being shaped, on the deformity. Any problem related to early and late postoperative period has not been seen in the 1 year follow up period. Our experience and 2 illustrative cases are presented.
The Fate of Hydroxyapatite Cement Used for Cranial Contouring: Histological Evaluation of a Case
Journal of Craniofacial Surgery, 2004
Craniofacial contouring is a commonly performed procedure applied for traumatic and postsurgical cranial vault or facial skeleton irregularities. Hydroxyapatite cement is an alloplastic material composed of tetracalcium phospate and dicalcium phospate anhydrous that transforms into a pastelike substance when these two compounds placed in an aqueous environment. This mixture, which is a nonceramic microporous calcium phosphate combination, is another alternative for refining the craniofacial contour. There are not enough data regarding bone formation within this material after its use in human beings, however. A case requiring secondary craniofacial contouring after a motor vehicle accident is presented. Hydroxyapatite cement was used for reconstruction, and a second look was carried out for further correction during which secondary contouring of the cement was made and a sample of the previously implanted material was histologically evaluated. It was observed in this case that hydroxyapatite cement is incorporated within the surrounding bony structures and permits secondary contouring procedures. New bone and vessel formation was also detected within the implanted material, but this was limited and thus was not convincing for significant osteoconversion as seen in animal studies.