Summary
Reconstruction of cranial defects can be reasonably considered a failure if an aesthetically
obvious cranial contour deformity persists after surgery. Such unsatisfactory outcome
often results from variable resorption of bone grafts or infection, requiring removal
of implant. In considering further treatment for such failed cases, the use of alloplastic
implants is frequently warned as imprudent due to their theoretically increased potential
for infection; however, the validity of such caution has never been substantiated.
We describe a user-friendly, time- and cost-effective method of producing prefabricated
methyl methacrylate implants for the reconstruction of cranial defects, using readily
available computer-aided design and computer-aided manufacture facilities. This method
was carried out in 31 patients who presented with persistent cranial defects after
previously failed cranioplasty. The efficacy of this technique and the clinical outcome
of the patients in this series were analysed. All implants produced a precise fit,
with a reduction in operating time and satisfactory cosmesis having been achieved.
Infection that required removal of implant occurred in three patients (9.7%), and
one patient developed a dural tear, requiring repair. Customised fabricated alloplastic
implants provide a safe, accurate and efficient way of restoring normal cranial contours
in patients with cranial defects who have had previous failed cranioplasties.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Three-dimensional computed tomography imaging in craniofacial surgery: morphological study and clinical applications.Chang Gung Med J. 2003; 26: 1-11
- Analyze: a comprehensive, operator-interactive software package for multidimensional medical image display and analysis.Comput Med Imaging Graph. 1989; 13: 433-454
Amira webpage.
- Integration of laser surface digitizing with CAD/CAM techniques for developing facial prostheses. Part 2: development of molding techniques for casting prosthetic parts.Int J Prosthodont. 2003; 16: 543-548
- Custom cranioplasty using stereolithography and acrylic.Br J Plast Surg. 2000; 53: 200-204
- Custom implant design for patients with cranial defects.IEEE Eng Med Biol Mag. 2002; 21: 38-44
- Computer-aided reconstruction of traumatic fronto-orbital osseous defects: aesthetic considerations.Chang Gung Med J. 2004; 27: 283-291
- Reduction of operating time and blood transfusion for craniosynostosis by simulated surgery using three-dimensional solid models.Neurol Med Chir (Tokyo). 1999; 39 ([discussion 27]): 423-426
- Cost-effective patient-specific intraoperative molded cranioplasty.J Craniofac Surg. 2008; 19: 777-781
- Acrylic frontal cranioplasty.Head Neck Surg. 1986; 9: 32-41
- Taylored implants for alloplastic cranioplasty–clinical and surgical considerations.Acta Neurochir Suppl. 2005; 93: 127-129
- Individual prefabricated titanium implants in reconstructive craniofacial surgery: clinical and technical aspects of the first 22 cases.Plast Reconstr Surg. 1998; 102: 300-308
- Frontal cranioplasty: risk factors and choice of cranial vault reconstructive material.Plast Reconstr Surg. 1986; 77: 888-904
- Cranioplasty using polymethyl methacrylate prostheses.J Clin Neurosci. 2009; 16: 56-63
- Cranial reconstruction with computer-generated hard-tissue replacement patient-matched implants: indications, surgical technique, and long-term follow-up.Plast Reconstr Surg. 2002; 109: 864-871
- Computer-generated titanium cranioplasty: report of a new technique for repairing skull defects.Br J Neurosurg. 1992; 6: 343-350
- Cranioplasty with individual carbon fibre reinforced polymer (CFRP) medical grade implants based on CAD/CAM technique.Acta Neurochir (Wien). 2002; 144: 1193-1203
- Computer-designed prostheses for orbitocranial reconstruction.Plast Reconstr Surg. 1988; 81: 315-324
Rish BL, Dillon JD, Meirowsky AM, et al. Cranioplasty: a review of 1030 cases of penetrating head injury. Neurosurgery 1979;4:381–5.
Article info
Publication history
Published online: September 18, 2009
Accepted:
August 20,
2009
Received:
January 14,
2009
Footnotes
☆Presented in part at the 7th Asia Pacific Craniofacial Association meeting, Taipei, Taiwan, 5–8 October 2008.
Identification
Copyright
© 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
