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O.191 Cranial reconstruction with biomaterials. Our experience in the last 5 years
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Journal of Cranio-Maxillofacial Surgery 34(2006) Suppl. S1
survived during a follow-up of 3 years. Two of the 23 (9%) complicated tumour and trauma patients were re-operated due to a local mucocele. Conclusions: Treatment of severe head and neck defects with biomaterial is a suitable alternative to conventional methods. Bioactive materials seems to be stable and reliable in clinical follow-ups. The reconstructions with bioactive glass and hydroxyapatite are associated with good functional and aesthetic results without donor-site morbidity. O.191 Cranial reconstruction with biomaterials. Our experience in the last 5 years I. Zubillaga, G. S´anchez, J.J. Montalvo. Oral and Maxillofacial Surgery Department, University Hospital 12 de Octubre, Madrid, Spain Introduction: Craneofacial defects reconstruction is a challenging procedure. A craneoplasty implies the correction of cranial defects or deformities. Craniofacial trauma and neurosurgery procedures contribute with an important number of cases that allow the development of new biomaterials. Diferent techniques and materials have been employed in cranial reconstruction. However, still controversy continues about the material to be implanted. It depends on the size of the defect and the recipient zone. Objectives: Historic review of the different reconstructive techniques applied, discussing about advantages and drawbacks depending on the characteristics of the defect. Material and Methods: Retrospective study of 20 patients with cranial defects treated with a variety of biomaterials between 2001 and 2006 in the Oral and Maxillofacial surgery department. (University Hospital 12 de Octubre). Results: Advantages and drawbacks of different biomaterials, including titanium mesh, hydroxyapatite and HTR (Hard Tissue Replacement). Discussion about the ideal biomaterial to employ in different cases. Review of potential pitfalls. Conclusions: Excellent clinical result depends on: Rigid structure of the biomaterial; Adequate characteristics of the recipient zone; Correct management of paranasal sinuses O.192 Extraoral maxillofacial prosthetic rehabilitation using extraoral implants V. Terenzi, S. Buonaccorsi, A. Leonardi, G. Fini. Department of Maxillo-Facial Surgery, Sant’Andrea Hospital, II Faculty of Medicine, University of Rome “La Sapienza”, Italy Introduction and Objectives: Plastic surgical reconstruction of facial defects is often limited by insufficient residual tissue, vascular compromise subsequent to radiation, poor clinical conditions or patient choice. The pourpose of this study is to report results from our personal experience on 13 pts treated from May 2002 to November 2005. Materials and Methods: For the 13 pts enrolled in this study, 38 titanium implants were placed to support 10 auricular prosthesis (in 2 cases bilateral), 2 orbital prosthesis, 2 nasal prosthesis and 1 a complex midfacial prosthesis. Defects were congenital (N = 8), consequent to trauma (N = 2) and to demolitive surgery for malignant tumours (N = 3) and infection (N = 2). In 2 pts implants were placed in previously irradiated areas and one of them received HBO treatment. Clinical and radiological data were analysed at follow-up intervals of 1, 3 and 6 months. Results: Moderate peri-implant tissue reactions were observed in 30% of cases. Implant failure was observed for 2 of the 3 implants placed to support a nasal prosthesis in a HCV positive patient, with an important parodontal disease, that experienced
Abstracts, EACFMS XVIII Congress a post-infective necrosis of the nose after a liver transplantation. In this case it was necessary to place an adhesive prosthesis. An implant failure was also observed in a diabetic patient with an extensive midfacial defects due to a mycotic infection, but it did not compromise the retention of the prosthesis. Conclusions: In selected cases, osseointegrated extraoral implants are a reliable alternative in the management of ear, orbital, nose and complex facial defects. O.193 3D computer modeling of the facial curvature of revascularized bone transplant E. Verbo, S. Perfiliev, A. Nerobeyev, N. Rabuchina. Russian Center of Reconstructive Cranio-Maxillo-Facial Surgery, Moscow, Russia Purpose: To improve the functional and aesthetic results of operations involving the plastic elimination of combined facial defects through transplantation of revascularized bone, by making use of three-dimensional computer modelling. Materials and Method: Sixty eight patients suffering from various defects of the facial skeleton received transplants. Utilized in the operations were 20 iliac crest, 26 fibula and 22 rib autografts. Using computer tomography, all the necessary parameters of transplant curvature were identified. The method of calculating the necessary number and location of osteothomy incisions in a transplant depended on the volume and curvature of the donor bone. When using an iliac crest and a rib, osteothomy points are determined by analyzing the second derivative of the transplant curvature function in relation to the curvature function of the restored defect. When a fibula is utilized it is necessary to make determinations for both sides of the bone, since different facial skeleton reconstruction tasks demand wedge-shaped osteotomy in a variety of locations: on the lateral side of the fibula when restoring lower yaw angles and on the proximal side when restoring maxilla and chin curvature. Results: Making calculations of the points of osteotomy decreased the time necessary for bone modelling. This led to a reduction in the time of anoxie and the results of the treatment improved. Necrosis of the transplant was reduced by 9 percent. Conclusion: Making use of three-dimensional computer tomography to make pre-operational calculations in regard to defects and bone transplant material improved the functional and aesthetic results of operations. O.194 Digitally planned reconstruction of the facial contour in Parry-Romberg J.M. Plooij, F.A.C. Schutyser, S. Kunz, S.J. Berg´e. Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Introduction: Parry-Romberg is characterized by hemifacial atrophy of skin, fat, muscle, cartilage and sometimes bone. Onesided progressive asymmetry of the facial contour will develop in 2–10 years. Among others, diagnostic signs are a pigmentated atrophical skin and loss of soft tissue in the area of the chin. After stabilization of this process, the facial contour is asymmetric. Many surgical solutions have been suggested to correct the facial contour using both alloplastic materials and autologous grafts. Methods: We present a case of a 40-year-old woman, with leftsided hemifacial atrophy, in which several surgical procedures with e.g. silicone implant, did not lead to a satisfaction result. 3D digital planning programs (3dMD patient© and Maxilim© ) were used to plan the surgical treatment.
Journal of Cranio-Maxillofacial Surgery 34(2006) Suppl. S1
survived during a follow-up of 3 years. Two of the 23 (9%) complicated tumour and trauma patients were re-operated due to a local mucocele. Conclusions: Treatment of severe head and neck defects with biomaterial is a suitable alternative to conventional methods. Bioactive materials seems to be stable and reliable in clinical follow-ups. The reconstructions with bioactive glass and hydroxyapatite are associated with good functional and aesthetic results without donor-site morbidity. O.191 Cranial reconstruction with biomaterials. Our experience in the last 5 years I. Zubillaga, G. S´anchez, J.J. Montalvo. Oral and Maxillofacial Surgery Department, University Hospital 12 de Octubre, Madrid, Spain Introduction: Craneofacial defects reconstruction is a challenging procedure. A craneoplasty implies the correction of cranial defects or deformities. Craniofacial trauma and neurosurgery procedures contribute with an important number of cases that allow the development of new biomaterials. Diferent techniques and materials have been employed in cranial reconstruction. However, still controversy continues about the material to be implanted. It depends on the size of the defect and the recipient zone. Objectives: Historic review of the different reconstructive techniques applied, discussing about advantages and drawbacks depending on the characteristics of the defect. Material and Methods: Retrospective study of 20 patients with cranial defects treated with a variety of biomaterials between 2001 and 2006 in the Oral and Maxillofacial surgery department. (University Hospital 12 de Octubre). Results: Advantages and drawbacks of different biomaterials, including titanium mesh, hydroxyapatite and HTR (Hard Tissue Replacement). Discussion about the ideal biomaterial to employ in different cases. Review of potential pitfalls. Conclusions: Excellent clinical result depends on: Rigid structure of the biomaterial; Adequate characteristics of the recipient zone; Correct management of paranasal sinuses O.192 Extraoral maxillofacial prosthetic rehabilitation using extraoral implants V. Terenzi, S. Buonaccorsi, A. Leonardi, G. Fini. Department of Maxillo-Facial Surgery, Sant’Andrea Hospital, II Faculty of Medicine, University of Rome “La Sapienza”, Italy Introduction and Objectives: Plastic surgical reconstruction of facial defects is often limited by insufficient residual tissue, vascular compromise subsequent to radiation, poor clinical conditions or patient choice. The pourpose of this study is to report results from our personal experience on 13 pts treated from May 2002 to November 2005. Materials and Methods: For the 13 pts enrolled in this study, 38 titanium implants were placed to support 10 auricular prosthesis (in 2 cases bilateral), 2 orbital prosthesis, 2 nasal prosthesis and 1 a complex midfacial prosthesis. Defects were congenital (N = 8), consequent to trauma (N = 2) and to demolitive surgery for malignant tumours (N = 3) and infection (N = 2). In 2 pts implants were placed in previously irradiated areas and one of them received HBO treatment. Clinical and radiological data were analysed at follow-up intervals of 1, 3 and 6 months. Results: Moderate peri-implant tissue reactions were observed in 30% of cases. Implant failure was observed for 2 of the 3 implants placed to support a nasal prosthesis in a HCV positive patient, with an important parodontal disease, that experienced
Abstracts, EACFMS XVIII Congress a post-infective necrosis of the nose after a liver transplantation. In this case it was necessary to place an adhesive prosthesis. An implant failure was also observed in a diabetic patient with an extensive midfacial defects due to a mycotic infection, but it did not compromise the retention of the prosthesis. Conclusions: In selected cases, osseointegrated extraoral implants are a reliable alternative in the management of ear, orbital, nose and complex facial defects. O.193 3D computer modeling of the facial curvature of revascularized bone transplant E. Verbo, S. Perfiliev, A. Nerobeyev, N. Rabuchina. Russian Center of Reconstructive Cranio-Maxillo-Facial Surgery, Moscow, Russia Purpose: To improve the functional and aesthetic results of operations involving the plastic elimination of combined facial defects through transplantation of revascularized bone, by making use of three-dimensional computer modelling. Materials and Method: Sixty eight patients suffering from various defects of the facial skeleton received transplants. Utilized in the operations were 20 iliac crest, 26 fibula and 22 rib autografts. Using computer tomography, all the necessary parameters of transplant curvature were identified. The method of calculating the necessary number and location of osteothomy incisions in a transplant depended on the volume and curvature of the donor bone. When using an iliac crest and a rib, osteothomy points are determined by analyzing the second derivative of the transplant curvature function in relation to the curvature function of the restored defect. When a fibula is utilized it is necessary to make determinations for both sides of the bone, since different facial skeleton reconstruction tasks demand wedge-shaped osteotomy in a variety of locations: on the lateral side of the fibula when restoring lower yaw angles and on the proximal side when restoring maxilla and chin curvature. Results: Making calculations of the points of osteotomy decreased the time necessary for bone modelling. This led to a reduction in the time of anoxie and the results of the treatment improved. Necrosis of the transplant was reduced by 9 percent. Conclusion: Making use of three-dimensional computer tomography to make pre-operational calculations in regard to defects and bone transplant material improved the functional and aesthetic results of operations. O.194 Digitally planned reconstruction of the facial contour in Parry-Romberg J.M. Plooij, F.A.C. Schutyser, S. Kunz, S.J. Berg´e. Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Introduction: Parry-Romberg is characterized by hemifacial atrophy of skin, fat, muscle, cartilage and sometimes bone. Onesided progressive asymmetry of the facial contour will develop in 2–10 years. Among others, diagnostic signs are a pigmentated atrophical skin and loss of soft tissue in the area of the chin. After stabilization of this process, the facial contour is asymmetric. Many surgical solutions have been suggested to correct the facial contour using both alloplastic materials and autologous grafts. Methods: We present a case of a 40-year-old woman, with leftsided hemifacial atrophy, in which several surgical procedures with e.g. silicone implant, did not lead to a satisfaction result. 3D digital planning programs (3dMD patient© and Maxilim© ) were used to plan the surgical treatment.