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Desai R, Kapur Z, Hammond B, Dombaxe CP, Chavez-Herrera VR, Tabaee A, Anand VK, Kacker A, Schwartz TH. Safety and efficacy of hydroset cranioplasty as an adjunct to gasket-seal and nasoseptal flap closure of the skull base. A case-controlled study. Acta Neurochir (Wien) 2024; 166:256. [PMID: 38850489 DOI: 10.1007/s00701-024-06134-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/20/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Cerebrospinal fluid leak after endoscopic skull base surgery remains a significant complication. Several investigators have suggested Hydroset cranioplasty to reduce leak rates. We investigated our early experience with Hydroset and compared the rate of nasal complications and CSF leak rates with case-controlled historic controls. METHODS We queried a prospective database of patients undergoing first time endoscopic, endonasal resection of suprasellar meningiomas and craniopharyngiomas from 2015 to 2023. We compared cases closed with a gasket seal, Hydroset, and a nasoseptal flap with those closed with only a gasket seal and nasoseptal flap. Demographics, technical considerations and postoperative outcomes (SNOT-22) were compared. RESULTS Seventy patients met inclusion criteria, twenty patients in the Hydroset group (meningioma n = 12; craniopharyngioma n = 8) and 50 control patients (meningioma n = 25; craniopharyngioma n = 25). CSF diversion was used in fewer Hydroset patients (75%, 15/20) compared with control group (94%, 47/50; p = 0.02). CSF leak was less frequent in the Hydroset than the control group (5% versus 12%, p = 0.38). One Hydroset patient required delayed nasal debridement. SNOT-22 responses demonstrated no significant difference in sinonasal complaints between groups (Hydroset average SNOT-22 score 22.45, control average SNOT-22 score 25.90; p = 0.58). CONCLUSIONS We demonstrate that hydroxyapatite reconstruction leads to improved CSF leak control above that provided by the gasket-seal and nasoseptal flap, without significant associated morbidity as long as the cement is fully covered with vascularized tissue.
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Affiliation(s)
- Rupen Desai
- Department of Neurological Surgery, Weill Cornell Medicine, NewYork Presbyterian Hospital, New York, NY, USA
| | - Zoe Kapur
- Department of Neurological Surgery, Weill Cornell Medicine, NewYork Presbyterian Hospital, New York, NY, USA
| | - Benjamin Hammond
- Department of Neurological Surgery, Weill Cornell Medicine, NewYork Presbyterian Hospital, New York, NY, USA
| | - Cátia P Dombaxe
- Department of Neurological Surgery, Weill Cornell Medicine, NewYork Presbyterian Hospital, New York, NY, USA
| | | | - Abtin Tabaee
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Vijay K Anand
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Ashutosh Kacker
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medicine, NewYork Presbyterian Hospital, New York, NY, USA.
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
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Vahidi N, Kwak P, Sismanis D, Schuman T, Hawkins D, Lee TS. Management of Complications and Secondary Deformity After Fractures of the Midface, Orbit, and Upper Third of the Maxillofacial Skeleton. Otolaryngol Clin North Am 2023; 56:1151-1167. [PMID: 37442663 DOI: 10.1016/j.otc.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Craniomaxillofacial trauma is a challenging entity to manage effectively and often necessitates serial evaluation and treatment. A multidisciplinary team is best served to evaluate and treat these complex injury patterns with the use of necessary adjuncts, such as neuronavigation, intraoperative imaging, custom implant use, and virtual surgical planning. Complications of facial trauma can present at a spectrum of time points and manifest in a variety of manners and as such patients should be observed closely and longitudinally. Although not all complications and secondary deformities can be avoided, this article highlights some common pitfalls and our unique management strategies.
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Affiliation(s)
- Nima Vahidi
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, Clinic Box 980146, Academic Box 980237, Richmond, VA 23298-0146, USA
| | - Peter Kwak
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, Clinic Box 980146, Academic Box 980237, Richmond, VA 23298-0146, USA
| | - Dimitrios Sismanis
- Oculoplastic Surgery, Virginia Oculofacial Surgeons, 1630 WIlkes Ridges Parkway Suite 102, Richmond, VA 23233, USA
| | - Theodore Schuman
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, Clinic Box 980146, Academic Box 980237, Richmond, VA 23298-0146, USA
| | - Daniel Hawkins
- Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University, School of Dentistry, Dental Building 1, 521 North 11th Street, Richmond, VA 23298-0566, USA
| | - Thomas S Lee
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, Clinic Box 980146, Academic Box 980237, Richmond, VA 23298-0146, USA.
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Toader C, Eva L, Tataru CI, Covache-Busuioc RA, Bratu BG, Dumitrascu DI, Costin HP, Glavan LA, Ciurea AV. Frontiers of Cranial Base Surgery: Integrating Technique, Technology, and Teamwork for the Future of Neurosurgery. Brain Sci 2023; 13:1495. [PMID: 37891862 PMCID: PMC10605159 DOI: 10.3390/brainsci13101495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
The landscape of cranial base surgery has undergone monumental transformations over the past several decades. This article serves as a comprehensive survey, detailing both the historical and current techniques and technologies that have propelled this field into an era of unprecedented capabilities and sophistication. In the prologue, we traverse the historical evolution from rudimentary interventions to the state-of-the-art neurosurgical methodologies that define today's practice. Subsequent sections delve into the anatomical complexities of the anterior, middle, and posterior cranial fossa, shedding light on the intricacies that dictate surgical approaches. In a section dedicated to advanced techniques and modalities, we explore cutting-edge evolutions in minimally invasive procedures, pituitary surgery, and cranial base reconstruction. Here, we highlight the seamless integration of endocrinology, biomaterial science, and engineering into neurosurgical craftsmanship. The article emphasizes the paradigm shift towards "Functionally" Guided Surgery facilitated by intraoperative neuromonitoring. We explore its historical origins, current technologies, and its invaluable role in tailoring surgical interventions across diverse pathologies. Additionally, the digital era's contributions to cranial base surgery are examined. This includes breakthroughs in endoscopic technology, robotics, augmented reality, and the potential of machine learning and AI-assisted diagnostic and surgical planning. The discussion extends to radiosurgery and radiotherapy, focusing on the harmonization of precision and efficacy through advanced modalities such as Gamma Knife and CyberKnife. The article also evaluates newer protocols that optimize tumor control while preserving neural structures. In acknowledging the holistic nature of cranial base surgery, we advocate for an interdisciplinary approach. The ecosystem of this surgical field is presented as an amalgamation of various medical disciplines, including neurology, radiology, oncology, and rehabilitation, and is further enriched by insights from patient narratives and quality-of-life metrics. The epilogue contemplates future challenges and opportunities, pinpointing potential breakthroughs in stem cell research, regenerative medicine, and genomic tailoring. Ultimately, the article reaffirms the ethos of continuous learning, global collaboration, and patient-first principles, projecting an optimistic trajectory for the field of cranial base surgery in the coming decade.
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Affiliation(s)
- Corneliu Toader
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (D.-I.D.); (H.P.C.); (L.-A.G.); (A.V.C.)
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania
| | - Lucian Eva
- Department of Neurosurgery, Dunarea de Jos University, 800010 Galati, Romania
- Department of Neurosurgery, Clinical Emergency Hospital “Prof. Dr. Nicolae Oblu”, 700309 Iasi, Romania
| | - Catalina-Ioana Tataru
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Clinical Hospital of Ophthalmological Emergencies, 010464 Bucharest, Romania
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (D.-I.D.); (H.P.C.); (L.-A.G.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (D.-I.D.); (H.P.C.); (L.-A.G.); (A.V.C.)
| | - David-Ioan Dumitrascu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (D.-I.D.); (H.P.C.); (L.-A.G.); (A.V.C.)
| | - Horia Petre Costin
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (D.-I.D.); (H.P.C.); (L.-A.G.); (A.V.C.)
| | - Luca-Andrei Glavan
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (D.-I.D.); (H.P.C.); (L.-A.G.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (D.-I.D.); (H.P.C.); (L.-A.G.); (A.V.C.)
- Neurosurgery Department, Sanador Clinical Hospital, 010991 Bucharest, Romania
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Martinez OP, Le PB, Martinez CR, Chen E. Autologous Fat Versus Hydroxyapatite Cement for Use in Frontal Sinus Obliteration: Systematic Review and Meta-Analysis. Ann Plast Surg 2023; 91:497-502. [PMID: 37556560 DOI: 10.1097/sap.0000000000003581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND Frontal sinus obliteration is a possible terminus for the management of chronic sinusitis, frontal bone trauma, cancer extirpation, or mucocele. The mucosa of the sinus is stripped and space obliterated with either autogenic, allopathic, or synthetic materials. This study aimed to compare the outcomes of autologous fat and hydroxyapatite cement (HAC) for frontal sinus obliteration. METHODS A multidatabase systematic review was conducted to collect outcomes on frontal sinus obliterations with either autologous fat or HAC. Outcomes collected included infection of the frontal sinus or obliteration material, mucocele formation, skin infection at the operative site, hematoma or seroma, cosmetic defect, donor site infection, and need for revision procedure. Prevalence of outcomes was analyzed through meta-analysis of proportions. RESULTS Twenty studies were ultimately included in the meta-analysis. Sixteen studies reported outcomes for 667 patients obliterated with autologous fat, and 7 studies reported outcomes for 100 patients obliterated with HAC. Prevalence of infection of the frontal sinus or obliteration material, mucocele formation, skin infection at the operative site, hematoma or seroma, and cosmetic defect did not differ statistically between the cohorts. Donor site infection secondary to fat harvesting for fat obliteration had a prevalence of <0.01. Revision rate was 0.04 (95% confidence interval, 0.01-0.8) for fat obliteration and 0.10 (95% confidence interval, 0.00-0.33) for HAC obliteration. CONCLUSIONS No statistically significant differences in the studied outcomes were detected between obliterations with autologous fat and HAC, suggesting that either is equally suitable and may be up to the surgeon's preference.
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Affiliation(s)
| | - Paulina B Le
- Prisma Health-Midlands/University of South Carolina School of Medicine, Division of Plastic and Reconstructive Surgery, Columbia, SC
| | - Carlos R Martinez
- Prisma Health-Midlands/University of South Carolina School of Medicine, Division of Plastic and Reconstructive Surgery, Columbia, SC
| | - Elliott Chen
- Prisma Health-Midlands/University of South Carolina School of Medicine, Division of Plastic and Reconstructive Surgery, Columbia, SC
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Patel D, Tatum SA. Bone Graft Substitutes and Enhancement in Craniomaxillofacial Surgery. Facial Plast Surg 2023; 39:556-563. [PMID: 37473765 DOI: 10.1055/s-0043-1770962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Critical-sized bone defects are a reconstructive challenge, particularly in the craniomaxillofacial (CMF) skeleton. The "gold standard" of autologous bone grafting has been the work horse of reconstruction in both congenital and acquired defects of CMF skeleton. Autologous bone has the proper balance of the protein (or organic) matrix and mineral components with no immune response. Organic and mineral adjuncts exist that offer varying degrees of osteogenic, osteoconductive, osteoinductive, and osteostimulative properties needed for treatment of critical-sized defects. In this review, we discuss the various mostly organic and mostly mineral bone graft substitutes available for autologous bone grafting. Primarily organic bone graft substitutes/enhancers, including bone morphogenic protein, platelet-rich plasma, and other growth factors, have been utilized to support de novo bone growth in setting of critical-sized bone defects. Primarily mineral options, including various calcium salt formulation (calcium sulfate/phosphate/apatite) and bioactive glasses have been long utilized for their similar composition to bone. Yet, a bone graft substitute that can supplant autologous bone grafting is still elusive. However, case-specific utilization of bone graft substitutes offers a wider array of reconstructive options.
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Affiliation(s)
- Dhruv Patel
- Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, New York
| | - Sherard A Tatum
- Department of Otolaryngology and Pediatrics, SUNY Upstate Medical University, Syracuse, New York
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Jebapriya M, Venkatesan R, Ansar S, Kim SC. Enhancement of physicochemical characterization of nanocomposites on Ag +/Fe 2+ codoped hydroxyapatite for antibacterial and anticancer properties. Colloids Surf B Biointerfaces 2023; 229:113463. [PMID: 37481804 DOI: 10.1016/j.colsurfb.2023.113463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
The synthesis of nanosized Ag+/Fe2+ codoped hydroxyapatite (HAp) nanocomposite materials with antibacterial and anticancer characteristics is highly attractive for advancing the development of biological applications. The objective of this study was to evaluate the antibacterial and anticancer characteristics of Ag+/Fe2+ codoped hydroxyapatite materials. We developed a facile chemical precipitation method for the fabrication of Ag+/Fe2+:HAp nanocomposites. The developed Ag+/Fe2+:HAp nanocomposite materials were characterized with Fourier transform infrared spectroscopy (FTIR), X-ray powder diffraction (XRD), Raman spectroscopy, and transmission electron microscopy (TEM). For measuring the size of Ag+/Fe2+:HAp nanocomposites, dynamic light scattering (DLS) is an advantageous method. The chemical states and chemical composition of Ag+/Fe2+:HAp were observed by X-ray photoelectron spectroscopy (XPS) analysis. In addition, the antibacterial efficacy of Ag+/Fe2+:HAps against Gram-positive (S.aureus), and Gram-negative (S.typhi, and E.Coli) microorganisms is examined in this current study. Ag+/Fe2+:HAp nanocomposite materials have been evaluated for biological toxicity in vitro, and the results showed that the particles were excellent at identifying and killing cancer cells. In this respect, Ag+/Fe2+:HAp nanocomposites significantly impact human colon cancer cells (HT29) while have no effect on normal fibroblast cells (L929).
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Affiliation(s)
- M Jebapriya
- Department of Chemistry, Mar Ephraem College of Engineering and Technology, Elavuvillai, Marthandam, Tamil Nadu 629171, India
| | - Raja Venkatesan
- School of Chemical Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, Republic of Korea.
| | - Sabah Ansar
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
| | - Seong-Cheol Kim
- School of Chemical Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, Republic of Korea.
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Biocompatible Materials for Orbital Wall Reconstruction-An Overview. MATERIALS 2022; 15:ma15062183. [PMID: 35329635 PMCID: PMC8954765 DOI: 10.3390/ma15062183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/27/2022] [Accepted: 03/14/2022] [Indexed: 12/04/2022]
Abstract
The reconstruction of an orbit after complex craniofacial fractures can be extremely demanding. For satisfactory functional and aesthetic results, it is necessary to restore the orbital walls and the craniofacial skeleton using various types of materials. The reconstruction materials can be divided into autografts (bone or cartilage tissue) or allografts (metals, ceramics, or plastic materials, and combinations of these materials). Over time, different types of materials have been used, considering characteristics such as their stability, biocompatibility, cost, safety, and intraoperative flexibility. Although the ideal material for orbital reconstruction could not be unanimously identified, much progress has been achieved in recent years. In this article, we summarise the advantages and disadvantages of each category of reconstruction materials. We also provide an update on improvements in material properties through various modern processing techniques. Good results in reconstructive surgery of the orbit require both material and technological innovations.
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Ha CM, Hong SD, Choi JW, Seol HJ, Nam DH, Lee JI, Kong DS. Graded Reconstruction Strategy Using a Multilayer Technique Without Lumbar Drainage After Endoscopic Endonasal Surgery. World Neurosurg 2021; 158:e451-e458. [PMID: 34767991 DOI: 10.1016/j.wneu.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Sellar reconstruction following endoscopic endonasal surgery (EES) requires modification based on the degree of cerebrospinal fluid (CSF) leak. For high-flow (grade II or III according to Esposito et al. 2007) intraoperative CSF leak, lumbar drainage (LD), in addition to the multilayer closing technique, is generally recommended. However, LD occasionally has complications including postpuncture headache, overdrainage symptoms, and increased length of stay. We retrospectively evaluated the outcome of our graded reconstruction strategy using a multilayer technique with a novel material, without LD, after EES. METHODS Ninety-seven patients who underwent EES with grade II or III intraoperative CSF leak between June 2020 and March 2021 were retrospectively reviewed. For grade II CSF leak, fibrin sealant and a nasoseptal flap were placed; for grade III CSF leak, a multilayer technique was used in combination with collagen matrix, an acellular dermal graft, injectable hydroxyapatite (HXA), and a nasoseptal flap. Postoperatively, routine LD was not performed. RESULTS This study included 48 (49.5%) grade II and 49 (50.5%) grade III CSF leaks. At follow-up (mean, 8.7 months), no patient showed postoperative CSF leak in either group. No HXA-associated complications occurred. CONCLUSIONS A graded surgical repair strategy after EES could avoid postoperative CSF leak. Combined use of injectable HXA and acellular dermal grafts for high-flow CSF leak can limit LD requirement without significant risks.
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Affiliation(s)
- Chang-Min Ha
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Aghali A. Craniofacial Bone Tissue Engineering: Current Approaches and Potential Therapy. Cells 2021; 10:cells10112993. [PMID: 34831216 PMCID: PMC8616509 DOI: 10.3390/cells10112993] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/16/2021] [Accepted: 10/22/2021] [Indexed: 01/10/2023] Open
Abstract
Craniofacial bone defects can result from various disorders, including congenital malformations, tumor resection, infection, severe trauma, and accidents. Successfully regenerating cranial defects is an integral step to restore craniofacial function. However, challenges managing and controlling new bone tissue formation remain. Current advances in tissue engineering and regenerative medicine use innovative techniques to address these challenges. The use of biomaterials, stromal cells, and growth factors have demonstrated promising outcomes in vitro and in vivo. Natural and synthetic bone grafts combined with Mesenchymal Stromal Cells (MSCs) and growth factors have shown encouraging results in regenerating critical-size cranial defects. One of prevalent growth factors is Bone Morphogenetic Protein-2 (BMP-2). BMP-2 is defined as a gold standard growth factor that enhances new bone formation in vitro and in vivo. Recently, emerging evidence suggested that Megakaryocytes (MKs), induced by Thrombopoietin (TPO), show an increase in osteoblast proliferation in vitro and bone mass in vivo. Furthermore, a co-culture study shows mature MKs enhance MSC survival rate while maintaining their phenotype. Therefore, MKs can provide an insight as a potential therapy offering a safe and effective approach to regenerating critical-size cranial defects.
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Affiliation(s)
- Arbi Aghali
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA;
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47908, USA
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Nanoparticles and Nanostructured Surface Fabrication for Innovative Cranial and Maxillofacial Surgery. MATERIALS 2020; 13:ma13235391. [PMID: 33260938 PMCID: PMC7731022 DOI: 10.3390/ma13235391] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022]
Abstract
A novel strategy to improve the success of soft and hard tissue integration of titanium implants is the use of nanoparticles coatings made from basically any type of biocompatible substance, which can advantageously enhance the properties of the material, as compared to its similar bulk material. So, most of the physical methods approaches involve the compaction of nanoparticles versus micron-level particles to yield surfaces with nanoscale grain boundaries, simultaneously preserving the chemistry of the surface among different topographies. At the same time, nanoparticles have been known as one of the most effective antibacterial agents and can be used as effective growth inhibitors of various microorganisms as an alternative to antibiotics. In this paper, based on literature research, we present a comprehensive review of the mechanical, physical, and chemical methods for creating nano-structured titanium surfaces along with the main nanoparticles used for the surface modification of titanium implants, the fabrication methods, their main features, and the purpose of use. We also present two patented solutions which involve nanoparticles to be used in cranioplasty, i.e., a cranial endoprosthesis with a sliding system to repair the traumatic defects of the skull, and a cranial implant based on titanium mesh with osteointegrating structures and functional nanoparticles. The main outcomes of the patented solutions are: (a) a novel geometry of the implant that allow both flexible adaptation of the implant to the specific anatomy of the patient and the promotion of regeneration of the bone tissue; (b) porous structure and favorable geometry for the absorption of impregnated active substances and cells proliferation; (c) the new implant model fit 100% on the structure of the cranial defect without inducing mechanical stress; (d) allows all kinds of radiological examinations and rapid osteointegration, along with the patient recover in a shorter time.
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Las DE, Verwilghen D, Mommaerts MY. A systematic review of cranioplasty material toxicity in human subjects. J Craniomaxillofac Surg 2020; 49:34-46. [PMID: 33257187 DOI: 10.1016/j.jcms.2020.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/15/2020] [Accepted: 10/25/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Local and systemic toxic reactions to implanted materials can result in morbidities. However, little is reported about cranioplasty implants. Therefore, we performed a systematic review on the toxicity of different materials used for cranioplasty implants. MATERIALS AND METHODS A systematic search was conducted by browsing the Pubmed, Embase, and Cochrane Library databases. All human studies that identified toxic (aseptic) reactions to any types of material used as cranioplasty implants or onplants, published up to January 1, 2019, were included in the review. RESULTS Nineteen studies were identified. Collectively, 36 patients endured some type of toxic reaction to an implanted material. Eleven studies presented several types of toxicity for PMMA cranioplasties in several tissue types. One article highlighted the risk of neurotoxicity for PMMA cranioplasty. Three articles presented toxic reactions to calcium phosphate and titanium implants. Three additional articles presented toxic reactions to PEEK, polypropylene-polyester, and polyethylene. CONCLUSION All materials currently used for cranioplasty showed occasional toxicity and morbidities. Therefore, none can be considered completely biologically inert. We found that aseptic inflammatory reactions have been underreported in the literature due to a high incidence of infections with questionable evidence.
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Affiliation(s)
- David Emmanuel Las
- European Face Centre, University Hospital Brussels, Laarbeeklaan 101, B-1090, Brussels, Belgium.
| | - Denis Verwilghen
- Sydney School of Veterinary Sciences, Faculty of Science, University of Sydney, 410 Werombi Road, Brownlow Hill, NSW, 2570, Australia.
| | - Maurice Yves Mommaerts
- European Face Centre, University Hospital Brussels, Laarbeeklaan 101, B-1090, Brussels, Belgium.
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12
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Bailey J, Balls M. Clinical impact of high-profile animal-based research reported in the UK national press. BMJ OPEN SCIENCE 2020; 4:e100039. [PMID: 35047685 PMCID: PMC8647573 DOI: 10.1136/bmjos-2019-100039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 07/21/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We evaluated animal-based biomedical 'breakthroughs' reported in the UK national press in 1995 (25 years prior to the conclusion of this study). Based on evidence of overspeculative reporting of biomedical research in other areas (eg, press releases and scientific papers), we specifically examined animal research in the media, asking, 'In a given year, what proportion of animal research "breakthroughs"' published in the UK national press had translated, more than 20 years later, to approved interventions?' METHODS We searched the Nexis media database (LexisNexis.com) for animal-based biomedical reports in the UK national press. The only restrictions were that the intervention should be specific, such as a named drug, gene, biomedical pathway, to facilitate follow-up, and that there should be claims of some clinical promise. MAIN OUTCOME MEASURES Were any interventions approved for human use? If so, when and by which agency? If not, why, and how far did development proceed? Were any other, directly related interventions approved? Did any of the reports overstate human relevance? RESULTS Overspeculation and exaggeration of human relevance was evident in all the articles examined. Of 27 unique published 'breakthroughs', only one had clearly resulted in human benefit. Twenty were classified as failures, three were inconclusive and three were partially successful. CONCLUSIONS The results of animal-based preclinical research studies are commonly overstated in media reports, to prematurely imply often-imminent 'breakthroughs' relevant to human medicine.
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Affiliation(s)
| | - Michael Balls
- University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
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A Simple Bedside Technique for Quantifying Volumetric Defects Prior to Hydroxyapatite Cranioplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3009. [PMID: 32983770 PMCID: PMC7489623 DOI: 10.1097/gox.0000000000003009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 06/10/2020] [Indexed: 11/25/2022]
Abstract
Contour irregularities following pediatric craniofacial surgery are common. Hydroxyapatite cranioplasty is a successful technique for optimizing the aesthetic outcome in these patients. We describe a simple technique that can be carried out at the bedside to calculate the volume of hydroxyapatite needed and therefore optimize the preoperative planning for hydroxyapatite cranioplasty.
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Use of Onlay Hydroxyapatite Cement for Secondary Cranioplasty. J Craniofac Surg 2020; 32:300-304. [PMID: 32969929 DOI: 10.1097/scs.0000000000007092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children who undergo bi-fronto-orbital advancement (BFOA) frequently develop a contour deformity on the temporal and supra-orbital region, with an incidence reported as high as 55% and 75%, respectively. Up to 20% of patients may require correction. Hydroxyapatite cement (HAC) is a good alternative to autogenous tissue. The available literature on its use focusses on the reconstruction of bone defects, but little has been published on its efficacy and safety as an onlay graft over intact cranium. OBJECTIVES To describe our institution's experience with HAC in the pediatric population. METHODS Retrospective chart review from 1998 to 2018 on all patients from the Craniofacial Unit at the Sydney Children's Hospital who had either coronal or metopic craniosynostosis and underwent BFOA and later in life required cranioplasty with HAC for contour repair. FINDINGS We have performed 166 BFOA and nineteen secondary cranioplasties for contour repair using onlay HAC. The mean age at the time of operation was 14 years. Bi-coronal craniosynostosis was most frequently associated with secondary cranioplasty and 37% had an associated syndrome. The mean volume of HAC used was 37 mL. There was only 1 patient who had a complication (5.3%) and required partial removal of allograft. The mean length of admission was 2 days. Mean follow up time of 22.4 months. CONCLUSIONS HAC represents a safe option when used correctly, with low rates of complication and satisfactory cosmetic outcomes.
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Garcia CM, Toms SA. A cautionary tale of hydroxyapatite cement use in frontal sinus obliteration. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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16
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Ahn JC, Cho SW, Kim DK, Han DH, Kim DY, Rhee CS, Lee CH, Kim YH, Paek SH, Won TB. Recovery period of sinonasal quality of life and its associated factors after endoscopic endonasal approach for anterior skull base tumors. Acta Otolaryngol 2019; 139:461-466. [PMID: 30806120 DOI: 10.1080/00016489.2019.1574982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Although endoscopic endonasal approach (EEA) for skull base tumors showed a good prognosis in sinonasal quality of life (QOL), what factors have influence on QOL is still in question. Aim/Objectives: To investigate the recovery of sinonasal QOL after EEA for anterior skull base tumors and find its prognostic factors. MATERIAL AND METHODS The study enrolled 250 patients undergoing EEA for anterior skull base tumors over 3 years. Sinonasal QOL was evaluated via sinonasal outcome test (SNOT-22) during 6 months. Age, gender, previous surgery, surgical extent, tumor pathology, combined surgical procedures, and surgical complications were analyzed. RESULTS There were 101 male and 149 female with average 48.6 ± 16.1 years old. SNOT-22 increased from baseline (median 17.0; Q1-Q3 8.25-30.0) to postoperative 1 and 3 months (27.0; 15.0-36.0; p < .001 and 20.5; 11.0-32.0; p = .021, respectively) and it returned to the baseline within 6 months. Reconstruction with calcium hydroxyapatite and postoperative mucosal edema had a negative impact on the recovery (p = .016 and .010, respectively), after adjustment for the baseline scores and postoperative months. CONCLUSIONS AND SIGNIFICANCE Sinonasal QOL was recovered within 6 months. Avoidance of calcium hydroxyapatite could prevent delayed recovery. Surgeons should carefully manipulate nasal mucosa to minimize postoperative mucosal edema.
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Affiliation(s)
- Jae-Cheul Ahn
- Department of Otorhinolaryngology - Head and Neck Surgery, Bundang CHA Medical Center, Seongnam, Republic of Korea
| | - Sung-Woo Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - Doo Hee Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong-Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul Hee Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Arnold MA, Tatum SA. Frontal Sinus Fractures: Evolving Clinical Considerations and Surgical Approaches. Craniomaxillofac Trauma Reconstr 2019; 12:85-94. [PMID: 31073357 DOI: 10.1055/s-0039-1678660] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022] Open
Abstract
Frontal sinus fractures are an uncommon injury of the maxillofacial skeleton, and account for 5-15% of all maxillofacial fractures. As the force of impact increases, fractures may extend beyond the anterior table to involve adjacent skull, posterior table and frontal sinus outflow tract (FSOT). Fractures at these subsites should be evaluated independently to assess the need for and type of operative intervention. Historically, these fractures were managed aggressively with open techniques resulting in obliteration or cranialization. With significant injuries, these approaches are still indispensable. However, the treatment of frontal sinus fractures has changed dramatically over the past half-century, and recent case series have demonstrated favorable outcomes with conservative management. Concurrently, there has been an increasing role of minimally invasive endoscopic techniques, both for primary and expectant management, with a focus on sinus preservation. Here, we review the diagnosis and management of frontal sinus fractures, with an emphasis on subsite evaluation. Following a detailed assessment, an appropriate treatment strategy is selected from a variety of open and minimally invasive approaches available in the surgeon's armamentarium.
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Affiliation(s)
- Mark A Arnold
- Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, New York
| | - Sherard A Tatum
- Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, New York
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Pourdanesh F, Latifi N, Latifi F. Complications after craniofacial reconstruction with calcium phosphate cements: a case report and review of the literature. J Korean Assoc Oral Maxillofac Surg 2018; 44:207-211. [PMID: 30402411 PMCID: PMC6209695 DOI: 10.5125/jkaoms.2018.44.5.207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/31/2018] [Accepted: 02/12/2018] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Fereydoun Pourdanesh
- Department of Oral and Maxillofacial Surgery, Taleghani Hospital, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Noorahmad Latifi
- Department of Plastic and Reconstructive Surgery, Hazrate Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Latifi
- Department of Oral and Maxillofacial Surgery, Taleghani Hospital, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Aksakal B, Demirel M, Sinirlioglu ZA. Synthesizing selenium- and silver-substituted hydroxyapatite-based bone grafts and their effects on antibacterial efficiency and cell viability. ACTA ACUST UNITED AC 2018; 63:291-300. [PMID: 29738308 DOI: 10.1515/bmt-2017-0230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/29/2018] [Indexed: 11/15/2022]
Abstract
Hydroxyapatite (HA)-based biografts with selenium (Se) and silver (Ag) substitutions were synthesized using the sol-gel method. The synthesized HA-based biografts at various Se and Ag quantity ratios (wt%) were characterized via Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM) and energy dispersive X-Ray spectroscopy (EDX). Escherichia coli (JM103) and Gram-positive Staphylococcus aureus (ATCC29293) bacteria were used for the cell viability tests by performing the MTT assay. During antibacterial tests, it was determined that the synthesized biografts showed significant antimicrobial activity on E. coli and S. aureus; however, some materials were effective on Gram-negative E. coli, but had no effect on Gram-positive S. aureus. In vitro cell viability tests revealed that some of the synthesized biografts such as H30Ag10Se15 and H40Ag20Se10 provided the highest cell viability rates compared to those in the control group.
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Affiliation(s)
- Bunyamin Aksakal
- Yildiz Technical University, Faculty of Chemical and Metallurgy, Department of Metallurgy and Materials Engineering, Istanbul, Turkey, Phone: +90 212 383 4690, E-mail:
| | - Mehtap Demirel
- Adiyaman University, Vocational School of Technical Science, Adiyaman, Turkey
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Monmaturapoj N, Sri-On A, Klinsukhon W, Boonnak K, Prahsarn C. Antiviral activity of multifunctional composite based on TiO 2-modified hydroxyapatite. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 92:96-102. [PMID: 30184826 DOI: 10.1016/j.msec.2018.06.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 05/11/2018] [Accepted: 06/18/2018] [Indexed: 11/30/2022]
Abstract
An antiviral activity of TiO2-modified hydroxyapatite composite (HA/TiO2) had been investigated. The HA/TiO2 composite (HA50:Ti50) was prepared by a solid state reaction method followed by calcination at 650 °C for 2 h. Phase formations and morphologies of the obtained HA/TiO2 composite powders were determined using XRD and SEM. XRD result confirmed that HA/TiO2 composite was successfully prepared. SEM revealed small crystals of anatase TiO2 embedded in larger HA crystals. A strong antiviral activity against H1N1 Influenza A Virus was observed at 0.5 mg/ml concentration of the composite under the UV irradiation for 60 min. It showed the highest rate of reducing virus titer approximately more than 2 log/h. Results obtained from this study indicated that HA/TiO2 composite could be a promising material to be used as antimicrobial filtration applications such as in face masks.
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Affiliation(s)
- Naruporn Monmaturapoj
- National Metal and Materials Technology Center, 114 Thailand Science Park, Pathumthani 12120, Thailand.
| | - Autcharaporn Sri-On
- National Metal and Materials Technology Center, 114 Thailand Science Park, Pathumthani 12120, Thailand
| | - Wattana Klinsukhon
- National Metal and Materials Technology Center, 114 Thailand Science Park, Pathumthani 12120, Thailand
| | - Kobporn Boonnak
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, 10400 Bangkok, Thailand
| | - Chureerat Prahsarn
- National Metal and Materials Technology Center, 114 Thailand Science Park, Pathumthani 12120, Thailand
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Abstract
Calvarial reconstruction is a challenge to reconstructive surgeons, especially considering protection of intracranial contents. In recent years, the advent of multiple reconstructive materials adds tools to the surgical armamentarium. Options include autologous split calvarial and rib grafts and alloplastic materials such as titanium mesh, methyl methacrylate, calcium hydroxyapatite, and polyetheretherketone. The most important aspect of cranial reconstruction still lies in finding the most aesthetic, safe, and reliable means of filling a defect.
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Affiliation(s)
- Arvind Badhey
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York
| | - Sameep Kadakia
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Moustafa Mourad
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Jared Inman
- Department of Otolaryngology, Loma Linda University, Loma Linda, California
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Kwon D, Iloreta A, Miles B, Inman J. Open Anterior Skull Base Reconstruction: A Contemporary Review. Semin Plast Surg 2017; 31:189-196. [PMID: 29075157 DOI: 10.1055/s-0037-1607273] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Skull base extirpative and reconstructive surgery has undergone significant changes due to technological and operative advances. While endoscopic resection and reconstruction will continue to advance skull base surgery for the foreseeable future, traditional open surgical approaches and reconstructive techniques are still contemporarily employed as best practices in certain tumors or patient-specific anatomical cases. Skull base surgeons should strive to maintain a working knowledge and technical skill set to manage these challenging cases where endoscopic techniques have previously failed, are insufficient from anatomical constraints, or tumor biology with margin control supersedes the more minimally invasive approach. This review focuses on the reconstructive techniques available to the open skull base surgeon as an adjunct to the endoscopic reconstructive options. Anatomic considerations, factors relating to the defect or patient, reconstructive options of nonvascular grafts, local and regional flaps, and free tissue transfer are outlined using the literature and author's experience. Future directions in virtual surgical planning and emerging technologies will continue to enhance open and endoscopic skull base surgeon's preparation, performance, and outcomes in this continually developing interdisciplinary field.
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Affiliation(s)
- Daniel Kwon
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California
| | - Alfred Iloreta
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett Miles
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jared Inman
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California
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Abstract
BACKGROUND Reconstruction of cranial defects due to trauma or other causes has been carried out since ages with a wide variety of materials. The aim of reconstruction was mainly to restore cosmesis and protect the brain from further injury. However, recent studies have shown that cranioplasty not only improves the cerebral blood flow but also leads to improvement of cognitive functions. The materials used include autologous bone, allogeneic bone, xenografts, and alloplasts. The search for an ideal material continues. The authors present their experience with cranioplasty using prefabricated porous polyethylene implants. MATERIALS AND METHODS Patients requiring cranioplasty for reconstruction of large sized (more than 15 cm in any 1 dimension) cranial defects were selected. Three patients were men and 2 were women. The age group of the patient ranged from 18 to 58 years. Preformed Biopore Hemisphere was used in every patient for cranial reconstruction. RESULTS No complications were seen in our patients. One patient who had undergone titanium cranioplasty previously showed remarkable improvement in cognitive functions. CONCLUSION Porous polyethylene prefabricated implants are a good restorative material for reconstruction of large cranial defects.
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Mehta RP, Cueva RA, Brown JD, Fliss DM, Gil Z, Kassam AB, Rassekh CH, Schlosser RJ, Snyderman CH, Har-El G. What's New in Skull Base Medicine and Surgery? Skull Base Committee Report. Otolaryngol Head Neck Surg 2016; 135:620-30. [PMID: 17011428 DOI: 10.1016/j.otohns.2006.04.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Accepted: 04/27/2006] [Indexed: 11/28/2022]
Affiliation(s)
- Ritvik P Mehta
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
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Kim YW, Lee DH, Cheon YW. Secondary Reconstruction of Frontal Sinus Fracture. Arch Craniofac Surg 2016; 17:103-110. [PMID: 28913266 PMCID: PMC5556797 DOI: 10.7181/acfs.2016.17.3.103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/11/2022] Open
Abstract
Fractures of frontal sinus account for 5%-12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.
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Affiliation(s)
- Yang Woo Kim
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Hun Lee
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Young Woo Cheon
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Infectious Complication Following Midface Reconstruction With Calcified Triglyceride. Ophthalmic Plast Reconstr Surg 2016; 31:e157-9. [PMID: 24901377 DOI: 10.1097/iop.0000000000000193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This case report describes an infectious complication related to the use of calcified triglyceride (Kryptonite Bone Cement) in post-traumatic midface reconstruction. Ultimately, the infected material required removal, and the facial deformity was repaired with subsequent procedures. The literature suggests that bone cement products should be used with caution when in contact with the paranasal sinuses.
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Regenerative Engineering in Maxillofacial Reconstruction. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2016. [DOI: 10.1007/s40883-016-0009-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Ducic Y, Miles BA, Sabatini P. Extending the traditional resection limits of squamous cell carcinoma of the anterior skull base. Otolaryngol Head Neck Surg 2016; 137:899-905. [DOI: 10.1016/j.otohns.2007.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Revised: 08/23/2007] [Accepted: 09/06/2007] [Indexed: 11/28/2022]
Abstract
Objective Preliminary report to evaluate the efficacy of resection of squamous cell carcinomas that demonstrate intracra-nial invasion. Methods A retrospective review of all cases of extracranial squamous cell carcinomas that extend intracranially treated by a single surgeon. Results A total of 21 cases were reviewed. In 6 cases, there was noted to be overt brain invasion. Complete resection of the intracranial disease was achieved in each of the remaining 15 cases. There were no instances of CSF leak, meningitis, brain abscess, stroke, or other intracranial complication noted either acutely or secondarily. In follow-ups that ranged from 10 months (single patient died of disease at 10 months) to 6 years (average, 3.8 years), there were no instances of intracranial recurrence. There was a disease-free control rate of 67.7% at an average follow-up of 4.1 years. Conclusions Extending the resection of squamous cell carcinoma into the intracranial vault judiciously as outlined appears to be associated with acceptable outcomes in the treatment of advanced squamous cell carcinoma of the skull base.
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Affiliation(s)
- Yadranko Ducic
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, and the Division of Otolaryngology and Facial Plastic Surgery, Dallas
- John Peter Smith Hospital, Fort Worth
| | - Brett A. Miles
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, and the Division of Otolaryngology and Facial Plastic Surgery, Dallas
| | - Peter Sabatini
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, and the Division of Otolaryngology and Facial Plastic Surgery, Dallas
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Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, Scarpa A, Cassandro E, Re M. Outcomes and complications in superior semicircular canal dehiscence surgery: A systematic review. Laryngoscope 2015; 126:1218-24. [DOI: 10.1002/lary.25662] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Shaniko Kaleci
- Department of Diagnostic Medicine; Clinical and Public Health University Hospital of Modena; Modena Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery; University of Salerno; Salerno Italy
| | - Ettore Cassandro
- Department of Medicine and Surgery; University of Salerno; Salerno Italy
| | - Massimo Re
- Otolaryngology Department; Marche Polytechnic University; Ancona Italy
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31
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Watanabe S, Amagasaki K, Naemura K, Nakaguchi H. Exposure of Titanium Mesh after Cranioplasty for Microvascular Decompression Surgery: Two Case Reports. NMC Case Rep J 2015; 2:132-134. [PMID: 28663983 PMCID: PMC5364882 DOI: 10.2176/nmccrj.2014-0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 05/21/2015] [Indexed: 11/28/2022] Open
Abstract
Two cases of exposed titanium mesh occurred after implantation for cranioplasty after repeated procedures for microvascular decompression (MVD). Case 1 was a 62-year-old female who underwent MVD for left hemifacial spasm followed by repair of cerebrospinal fluid leak after the surgery, and Case 2 was a 75-year-old female who underwent MVD twice for right trigeminal neuralgia. Both patients visited our hospital again with complaints of postauricular lesion. Titanium mesh was visible through the operative scar and was successfully removed with no complication in both cases. Both patients were underweight females, and combined with multistep surgery may have contributed to the pathology. The present cases suggest that use of titanium mesh should be avoided for cranioplasty of posterior fossa surgery, especially for repeated procedures.
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Affiliation(s)
- Saiko Watanabe
- Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo
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Profeta AC, Huppa C. Bioactive-glass in Oral and Maxillofacial Surgery. Craniomaxillofac Trauma Reconstr 2015; 9:1-14. [PMID: 26889342 DOI: 10.1055/s-0035-1551543] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/24/2015] [Indexed: 10/23/2022] Open
Abstract
The use of synthetic materials to repair craniofacial defects is increasing today and will increase further in the future. Because of the complexity of the anatomy in the head and neck region, reconstruction and augmentation of this area pose a challenge to the surgeon. This review discusses key facts and applications of traditional reconstruction bone substitutes, also offering comparative information. It then describes the properties and clinical applications of bioactive-glass (B-G) and its variants in oral and maxillofacial surgery, and provides clinical findings. The discussion of each compound includes a description of its composition and structure, the advantages and shortcomings of the material, and its current uses in the field of osteoplastic and reconstructive surgery. With a better understanding of the available alloplastic implants, the surgeon can make a more informed decision as to which implant would be most suitable in a particular patient.
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Affiliation(s)
- Andrea Corrado Profeta
- Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Jena, Germany
| | - Christoph Huppa
- Department of Oral and Maxillofacial Surgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
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Shirosaki Y, Okamoto K, Hayakawa S, Osaka A, Asano T. Preparation of Porous Chitosan-Siloxane Hybrids Coated with Hydroxyapatite Particles. BIOMED RESEARCH INTERNATIONAL 2015; 2015:392940. [PMID: 26078948 PMCID: PMC4452833 DOI: 10.1155/2015/392940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/13/2014] [Indexed: 11/17/2022]
Abstract
This paper describes the apatite deposition of chitosan-silicate porous hybrids derived from chitosan and γ-glycidoxypropyltrimethoxysilane (GPTMS) in alkaline phosphate solution. The preparation of porous hybrids with needle-like apatite on their surfaces is described. Following apatite deposition the porous hybrids maintained high porosity. The enzymatic degradation rate was low even after 6 months and the porous hybrids were very flexible and cut easily using surgical scissors.
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Affiliation(s)
- Yuki Shirosaki
- Frontier Research Academy for Young Researchers, Kyushu Institute of Technology, 2-4 Hibikino, Wakamatsu-ku, Kitakyushu 808-0196, Japan
| | - Kohei Okamoto
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsushima-naka, Kita-ku, Okayama 700-8530, Japan
| | - Satoshi Hayakawa
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsushima-naka, Kita-ku, Okayama 700-8530, Japan
| | - Akiyoshi Osaka
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsushima-naka, Kita-ku, Okayama 700-8530, Japan
| | - Takuji Asano
- Nikkiso Co., Ltd., Ebisu, Shibuya-ku, Tokyo 150-6022, Japan
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Williams L, Fan K, Bentley R. Custom-made titanium cranioplasty: early and late complications of 151 cranioplasties and review of the literature. Int J Oral Maxillofac Surg 2015; 44:599-608. [DOI: 10.1016/j.ijom.2014.09.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 08/27/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
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Naderi N, Ardehali B, Mosahebi A. Biomaterials and structural fat grafting. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kumar NG, Sudeep S, Balwan R. Cranioplasty of Hemispherical Defects Using Calcium Phosphate Cements Along with Titanium Mesh: Our Experience. J Maxillofac Oral Surg 2015; 14:920-4. [PMID: 26604464 DOI: 10.1007/s12663-015-0776-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/28/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION 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. MATERIALS AND METHODS 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 mesh was adapted to the defect for support. Then the calcium phosphate cement was prepared and injected on the mesh to establish good contour. The alloplastic insert in each patient was evaluated for: (a) Immediate post-operative complications (b) Restoration of contour and soft tissue support (c) New bone formation ascertained on HRCT at the end of 2 years. Patients were examined on postoperative first week, at 3 and at 6 months. High resolution computed tomography scans were taken at 2 years postop. There were two female and three male patients. RESULTS There were no complications in the post operative period. The general condition of the patients improved post operatively. Even though the cements maintained their contour at 2 years, there were no signs of bone formation within the cement. CONCLUSION Calcium phosphate cement is a good bone substitute for use in cranioplasty. In defects requiring mechanical strength, it should be supported by a titanium mesh. It retains the contour but is not replaced by bone even after 2 years.
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Affiliation(s)
- N Girish Kumar
- Department of Oral and Maxillofacial Surgery, Swami Devi Dyal College, Barwala, Panchkula, Haryana India
| | - S Sudeep
- Department of Maxillofacial Surgery, 16 CDU, C/O 56 APO, Panchkula, India
| | - Rahul Balwan
- Department of Oral and Maxillofacial Surgery, Swami Devi Dyal College, Barwala, Panchkula, Haryana India
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Komakula SSB, Raut S, Verma NP, Raj TA, Kumar MJ, Sinha A, Singh S. Assessment of injectable and cohesive nanohydroxyapatite composites for biological functions. Prog Biomater 2015; 4:31-38. [PMID: 29470792 PMCID: PMC5151109 DOI: 10.1007/s40204-014-0034-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 12/04/2014] [Indexed: 11/30/2022] Open
Abstract
Pressing need for utilization of injectables/fillers in various forms of orthopaedic treatments/surgeries commands an equal demand for better graft material. Injectable bone graft material based on biomimetically synthesized nanohydroxyapatite was developed and subjected to ball milling for different times; three materials thus produced were evaluated for their biological properties. The three composites tested were found to have some difference in proliferation and differentiation on mesenchymal stem cells in cultures. In vivo studies were performed by implanting the graft materials with or without cells in the bone drill hole injury created in the femur of Wistar rats. Our studies show that the composites lead to well-healed injury site with normal histology without inflammation or fibrous tissue formation and bone deformity. This material needs to be tested on large animals for further ascertaining its applicability in clinical use.
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Affiliation(s)
| | - Snehal Raut
- CSIR-Centre for Cellular and Molecular Biology, Uppal Road, Hyderabad, 500 007, India
| | | | - T Avinash Raj
- CSIR-Centre for Cellular and Molecular Biology, Uppal Road, Hyderabad, 500 007, India
| | - Mahesh J Kumar
- CSIR-Centre for Cellular and Molecular Biology, Uppal Road, Hyderabad, 500 007, India
| | - Arvind Sinha
- CSIR-National Metallurgical Laboratory, Jamshedpur, 831 007, India
| | - Shashi Singh
- CSIR-Centre for Cellular and Molecular Biology, Uppal Road, Hyderabad, 500 007, India.
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Watanabe S, Amagasaki K, Naemura K, Nakaguchi H. Exposure of Titanium Mesh after Cranioplasty for Microvascular Decompression Surgery: Two Case Reports. NMC Case Rep J 2015. [DOI: 10.2176/nmccrj.cr.2014-0444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lid cranioplasty: an elegant method of calvarial reconstruction. J Craniofac Surg 2014; 25:2172-3. [PMID: 25318445 DOI: 10.1097/scs.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The reconstruction of calvarial defect is a challenging treat for any craniofacial surgeon. The split calvarial bone graft reconstruction is a well-described method of reconstruction and gives very good results. Here, we present a 14-year-old girl who presented with a frontal cranial bone defect with a size of 5 × 3 cm for which the reconstruction was done with a split calvarial bone graft taken from the parietal bone. The method of reconstruction resembled keeping a lid of a jar, and we named this procedure lid cranioplasty. We were able to come out with very good cosmetic and functional outcome.
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Choudhry OJ, Christiano LD, Arnaout O, Adel JG, Liu JK. Reconstruction of pterional defects after frontotemporal and orbitozygomatic craniotomy using Medpor Titan implant: Cosmetic results in 98 patients. Clin Neurol Neurosurg 2013; 115:1716-20. [DOI: 10.1016/j.clineuro.2013.03.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 03/26/2013] [Accepted: 03/29/2013] [Indexed: 11/26/2022]
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Belcarz A, Zima A, Ginalska G. Biphasic mode of antibacterial action of aminoglycoside antibiotics-loaded elastic hydroxyapatite–glucan composite. Int J Pharm 2013; 454:285-95. [DOI: 10.1016/j.ijpharm.2013.06.076] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 06/19/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
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Wiggins A, Austerberry R, Morrison D, Ho KM, Honeybul S. Cranioplasty with custom-made titanium plates--14 years experience. Neurosurgery 2013; 72:248-56; discussion 256. [PMID: 23149967 DOI: 10.1227/neu.0b013e31827b98f3] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is no consensus on which material is best suited for repair of cranial defects. OBJECTIVE To investigate the outcomes following custom-made titanium cranioplasty. METHODS The medical records for all patients who had titanium cranioplasty at 2 major neurosurgical centers in Western Australia were retrieved and analyzed for this retrospective cohort study. RESULTS Altogether, 127 custom-made titanium cranioplasties on 113 patients were included. Two patients had 3 titanium cranioplasties and 10 patients had 2. Infected bone flap (n = 61, 54%), either from previous craniotomy or autologous cranioplasty, and contaminated bone flap (n = 16, 14%) from the initial injury were the main reasons for requiring titanium cranioplasty. Complications attributed to titanium cranioplasty were common (n = 33, 29%), with infection being the most frequent complication (n = 18 patients, 16%). Complications were, on average, associated with an extra 7 days of hospital stay (interquartile range 2-17). The use of titanium as the material for the initial cranioplasty (P = .58), the presence of skull fracture(s) (P > .99) or scalp laceration(s) (P = .32) at the original surgery, and proven local infection before titanium cranioplasty (P = .78) were not significantly associated with an increased risk of infection. Infection was significantly more common after titanium cranioplasty for large defects (hemicraniectomy [39%] and bifrontal craniectomy [28%]) than after cranioplasty for small defects (P = .04). CONCLUSION Complications after using titanium plate for primary or secondary cranioplasty were common (29%) and associated with an increased length of hospital stay. Infection was a major complication (16%), and this suggested that more vigorous perioperative infection prophylaxis is needed for titanium plate cranioplasty.
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Affiliation(s)
- Anthony Wiggins
- Department of Neurosurgery, Royal Perth Hospital, Perth, Western Australia, Australia.
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Zhou H, Deng Y, Bi X, Xiao C, Wang Y, Sun J, Gu P, Fan X. Orbital wall repair in canines with beta-tricalcium phosphate and induced bone marrow stromal cells. J Biomed Mater Res B Appl Biomater 2013; 101:1340-9. [PMID: 23687075 DOI: 10.1002/jbm.b.32951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 03/05/2013] [Accepted: 03/27/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Huifang Zhou
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
| | - Yuan Deng
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
| | - Xiaoping Bi
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
| | - Caiwen Xiao
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
| | - Yefei Wang
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
| | - Jing Sun
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
| | - Ping Gu
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
| | - Xianqun Fan
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
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Surgical capping of superior semicircular canal dehiscence. Eur Arch Otorhinolaryngol 2013; 271:1369-74. [DOI: 10.1007/s00405-013-2533-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 04/24/2013] [Indexed: 11/25/2022]
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Manjila S, Weidenbecher M, Semaan MT, Megerian CA, Bambakidis NC. Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh-hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma. J Neurosurg 2013; 119:113-20. [PMID: 23350781 DOI: 10.3171/2012.11.jns121365] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Several prophylactic surgical methods have been tried to prevent CSF leakage after translabyrinthine resection of acoustic neuroma (TLAN). The authors report an improvised technique for multilayer watertight closure using titanium mesh-hydroxyapatite cement (HAC) cranioplasty in addition to dural substitute and abdominal fat graft after TLAN. METHODS The study was limited to 42 patients who underwent TLAN at University Hospitals Case Medical Center using this new technique from 2006 to 2012. Systematic closure of the surgical wound in layers using temporalis fascia, dural substitute, dural sealant, adipose graft, titanium mesh, and then HAC was performed in each case. Temporalis muscle and eustachian tube obliteration were not used. The main variables studied were patient age, tumor size, tumor location, cosmetic outcome, length of hospitalization, and the incidence of CSF leak, pseudomeningocele, and infection. RESULTS Excellent cosmetic outcome was achieved in all patients. There were no cases of postoperative CSF rhinorrhea, incisional CSF leak, or meningitis. Cosmetic results were comparable to those achieved using HAC alone. This cost-effective technique used only a third of the HAC required for traditional closure in which the entire mastoid defect is filled with cement, predisposing to infection. Postoperative CT and MRI showed excellent bony contouring and dural reconstitution, respectively. CONCLUSIONS The authors report on successful use of titanium mesh-HAC cranioplasty in preventing postoperative CSF leak after TLAN in all cases in their series. The titanium mesh provides a well-defined anatomical dissection plane that would make reoperation easier than working through scarred soft tissue. The mesh bolsters the fat graft and keeps HAC out of direct contact with mastoid air cells, thereby reducing the risk of infection. The cement cranioplasty does not preclude subsequent implantation of a bone-anchored hearing aid.
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Affiliation(s)
- Sunil Manjila
- Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106, USA
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Bone morphogenetic proteins in craniofacial surgery: current techniques, clinical experiences, and the future of personalized stem cell therapy. J Biomed Biotechnol 2012; 2012:601549. [PMID: 23226941 PMCID: PMC3511855 DOI: 10.1155/2012/601549] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 10/16/2012] [Indexed: 12/29/2022] Open
Abstract
Critical-size osseous defects cannot heal without surgical intervention and can pose a significant challenge to craniofacial reconstruction. Autologous bone grafting is the gold standard for repair but is limited by a donor site morbidity and a potentially inadequate supply of autologous bone. Alternatives to autologous bone grafting include the use of alloplastic and allogenic materials, mesenchymal stem cells, and bone morphogenetic proteins. Bone morphogenetic proteins (BMPs) are essential mediators of bone formation involved in the regulation of differentiation of osteoprogenitor cells into osteoblasts. Here we focus on the use of BMPs in experimental models of craniofacial surgery and clinical applications of BMPs in the reconstruction of the cranial vault, palate, and mandible and suggest a model for the use of BMPs in personalized stem cell therapies.
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Goodrich JT, Sandler AL, Tepper O. A review of reconstructive materials for use in craniofacial surgery bone fixation materials, bone substitutes, and distractors. Childs Nerv Syst 2012; 28:1577-88. [PMID: 22872276 DOI: 10.1007/s00381-012-1776-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 04/13/2012] [Indexed: 11/29/2022]
Abstract
Over the last 40 years, craniofacial surgery, in general, and surgery for craniosynostosis, in particular, has witnessed the introduction of a number of new materials for use in operations involving the cranial vault. Some of these materials have proven quite useful over time, while others have failed to meet their stated objectives. In this review, the more popular implant materials are analyzed, and their relative merits and drawbacks are discussed. Craniofacial surgery in the pediatric population has its own unique limitations, quite different from the adult population and those issues are reviewed as well.
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Affiliation(s)
- James Tait Goodrich
- Division of Pediatric Neurosurgery, Leo Davidoff Department of Neurological Surgery, Children's Hospital at Montefiore, Bronx, New York, USA.
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Comparison of calcium phosphate preparations for onlay cranial augmentation in a murine model. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Calcium orthophosphate-based bone cements (CPCs): Applications, antibiotic release and alternatives to antibiotics. J Appl Biomater Funct Mater 2012; 10:2-11. [PMID: 22467044 DOI: 10.5301/jabfm.2012.9279] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2011] [Indexed: 11/20/2022] Open
Abstract
Calcium orthophosphate bone cements (CPCs) are widely used in orthopedic surgery. Implants are highly susceptible to infection and often lead to the formation of microbial biofilms. Antibiotics are often incorporated into bone cement to prevent infection. The increase in the number of microorganisms acquiring or developing resistance to antibiotics, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), is a major concern. Bacteriocins (antimicrobial peptides) offer an alternative to antibiotics. Their mode of activity involves permanent destabilization of the plasma membrane of target cells. A number of broad-spectrum bacteriocins produced by lactic acid bacteria and Bacillus spp. have recently been reported. In this REVIEW the major characteristics of calcium phosphate bone cements, prosthetic joint-associated infections, and treatment of these infections is discussed. The role of antimicrobial agents in CPCs is discussed and the possibility of incorporating bacteriocins in prosthetic devices is investigated.
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Aberg J, Henriksson HB, Engqvist H, Palmquist A, Brantsing C, Lindahl A, Thomsen P, Brisby H. Biocompatibility and resorption of a radiopaque premixed calcium phosphate cement. J Biomed Mater Res A 2012; 100:1269-78. [PMID: 22359393 DOI: 10.1002/jbm.a.34065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 10/28/2011] [Accepted: 12/08/2011] [Indexed: 11/10/2022]
Abstract
Calcium phosphate cements (CPC) are used as bone void filler in various orthopedic indications; however, there are some major drawbacks regarding mixing, transfer, and injection of traditional CPC. By using glycerol as mixing liquid, a premixed calcium phosphate cement (pCPC), some of these difficulties can be overcome. In the treatment of vertebral fractures the handling characteristics need to be excellent including a high radio-opacity for optimal control during injection. The aim of this study is to evaluate a radiopaque pCPC regarding its resorption behavior and biocompatibility in vivo. pCPC and a water-based CPC were injected into a Ø 4-mm drilled femur defect in rabbits. The rabbits were sacrificed after 2 and 12 weeks. Cross sections of the defects were evaluated using histology, electron microscopy, and immunohistochemical analysis. Signs of inflammation were evaluated both locally and systemically. The results showed a higher bone formation in the pCPC compared to the water-based CPC after 2 weeks by expression of RUNX-2. After 12 weeks most of the cement had been resorbed in both groups. Both materials were considered to have a high biocompatibility since no marked immunological response was induced and extensive bone ingrowth was observed. The conclusion from the study was that pCPC with ZrO(2) radiopacifier is a promising alternative regarding bone replacement material and may be suggested for treatment of, for example, vertebral fractures based on its high biocompatibility, fast bone ingrowth, and good handling properties.
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Affiliation(s)
- J Aberg
- Applied Materials Science, Department of Engineering Sciences, Uppsala University, Uppsala, Sweden.
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