Facial pain due to a displaced orbital floor implant: report of case

Medpor in maxillofacial deformities: report of three cases

OBJECTIVE

This paper deals with the usefulness and versatility of the porous high-density polyethylene implants for correction of various facial deformities as an augmentation and an onlay graft material with its advantages.

MATERIALS AND METHODS

Prefabricated porous high-density polyethylene implants were used in three patients (post-trauma facial deformity, Goldenhar syndrome, nasal deformity in cleft patient) for secondary reconstruction of orbital floor, depressed nose and supra-orbital ridge, augmentation of hypoplastic mandible and depressed nasal dorsum under general anaesthesia.

RESULTS

Good esthetic results were achieved in all the three patients treated with porous high-density polyethylene implants with no complications.

CONCLUSION

Porous high-density polyethylene alloplastic implant is an excellent biomaterial for reconstruction of various facial deformities with many advantages over autogenous and other alloplastic materials.

Facial skeletal reconstruction using porous polyethylene implants

A retrospective review of clinical outcomes was performed to determine the clinical utility and morbidity associated with the use of porous polyethylene facial implants. Three hundred seventy implants were placed in 162 consecutive patients, in 178 operations performed in 11 years. The number of patients, the number of implants used, and the average follow-up period were categorized according to the cause of the deformity. The resultant distribution was as follows: acquired (tumor-related), 17 patients, 39 implants, and 30 months; congenital, eight patients, 31 implants, and 92 months; aesthetic, 39 patients, 97 implants, and 24 months; secondary posttraumatic, 48 patients, 139 implants, and 37 months; and acute trauma (internal orbit reconstruction), 50 patients, 64 implants, and 9 months. The distribution of implants according to location was as follows: frontal, 21; temporal, 30; internal orbit, 145; infraorbital rim, 28; malar, 58; paranasal, 29; nasal, 13; mandible, 24; and chin, 22. The combined average follow-up period per patient was 27 months (range, immediate postoperative period to 11 years). All implants were placed in the subperiosteal plane, and the majority were fixed with titanium screws. Antibiotics were administered perioperatively. No implants were extruded or migrated, formed clinically apparent capsules, or caused symptoms attributable to bioincompatibility. The overall reoperation rate was 10 percent (n = 16), which included operations to remove implants because of acute infections (2 percent, n = 3) or a late infection (1 percent, n = 1), to remove implants causing displeasing contours (2 percent, n = 3), and to improve contours (6 percent, n = 9). Porous polyethylene implants have biomaterial properties favorable for facial skeletal augmentation. Screw application of the implants to the skeleton allows precise predictable contouring, thus limiting the need for revisional surgical procedures.

Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature

The use of implantable biomaterials has become an integral part of aesthetic and reconstructive surgery of the face. Metals are used for fracture fixation devices, whereas polymers are used primarily for bone or soft-tissue substitution. This review of the scientific literature examines the risks and complications of these materials. First, we present an overview of commonly used materials. Second, we address general considerations of toxicity relevant to all biomaterials. Third, we present data from a large number of clinical series on the incidence of complications for individual materials used in specific applications.

The use of silastic as an orbital implant for reconstruction of orbital wall defects: review of 311 cases treated over 20 years

PURPOSE

A retrospective review of silicone rubber (Silastic; Dow Corning, Midland, MI) implants placed in orbits was undertaken. These implants were used to reconstruct defects in the orbital floor and/or walls secondary to trauma, or those created during malar or orbital osteotomies. The purpose of the study was to determine the incidence of removal of these implants from the surgical site.

MATERIALS AND METHODS

The records of 311 patients treated over a 20-year period were reviewed. Of these, 302 had received silastic implants secondary to trauma.

RESULTS

Forty-one patients (13%) had their implant removed at a second operation. The reasons for removal included infection, migration of the implant, worsening eye sign such as diplopia, and others.

CONCLUSION

Because there was a clinically significant rate of removal of this material, consideration should be given to the use of other available materials.