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1.
Int J Oral Maxillofac Implants ; 35(5): 917-923, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991641

RESUMO

PURPOSE: Compaction of particulated grafts is done manually; thus, the effect of compression force on bone regeneration remains unclear. The aim of this study was to evaluate the impact of two different compression forces on the consolidation of particulated bovine hydroxyapatite. MATERIALS AND METHODS: Two titanium cylinders were fixed on the calvarium of eight New Zealand rabbits. Both defects were filled with particulated bovine hydroxyapatite subjected to a compression force of 0.7 kg/cm2 or 1.6 kg/cm2 before being covered with a resorbable collagen membrane. A handheld device that uses a spring to control the compression force applied by the plugger was used. At 6 weeks, histomorphometry of the area immediately adjacent to the calvaria bone and to the collagen membrane was performed. RESULTS: It was shown that next to the calvaria, the bone volume per tissue volume (BV/TV) was 29.0% ± 8.8% and 27.6% ± 8.2% at low and high compression force, respectively; the bone-to-biomaterial contact (BBC) was 58.2% ± 25.0% and 69.3% ± 22.9%, respectively (P > .05). In the corresponding area next to the collagen membrane, BV/TV was 4.9% ± 5.1% and 5.7% ± 4.7%, and the BBC was 18.3% ± 20.8% and 20.1% ± 15.9%, respectively (P > .05). In addition, the number and area of blood vessels were not significantly affected by compression force. CONCLUSION: Both compression forces applied resulted in similar consolidation of bovine hydroxyapatite expressed by new bone formation and vascularization based on a rabbit calvaria augmentation model.


Assuntos
Regeneração Óssea , Durapatita , Animais , Materiais Biocompatíveis , Bovinos , Colágeno , Coelhos , Crânio/cirurgia
2.
Khirurgiia (Mosk) ; (8): 17-22, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869610

RESUMO

OBJECTIVE: To evaluate the effectiveness of surgical treatment of post-burn defects of face and cranial vault. MATERIAL AND METHODS: There were 65 patients with post-burn defects of face and cranial vault. Mean age of patients was 38.5 years (min 17 years, max 67 years). Soft tissue reconstruction was performed by using of local tissues, combined plasty, balloon dermotension aand free flaps on microvascular anastomoses. Osteoectomy and sequestrectomy were carried out if it was necessary. Implants were used to eliminate through skull defects. RESULTS: Balloon dermotension with expanders and plasty with local tissues ensure skull reconstruction in the vast majority of patients. Through bone defects required reconstruction of the cranial vault with various implants. CONCLUSION: The proposed surgical approach ensures correction of severe functional and cosmetic disorders caused by post-burn skull defects, elimination of bone damage, restoration of normal skin of the face and cranial vault.


Assuntos
Queimaduras/cirurgia , Traumatismos Craniocerebrais/cirurgia , Face/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Adolescente , Adulto , Idoso , Queimaduras/complicações , Traumatismos Craniocerebrais/etiologia , Traumatismos Faciais/etiologia , Traumatismos Faciais/cirurgia , Retalhos de Tecido Biológico , Humanos , Microcirurgia , Pessoa de Meia-Idade , Implantação de Prótese , Estudos Retrospectivos , Crânio/lesões , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/cirurgia , Expansão de Tecido , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/cirurgia , Adulto Jovem
3.
Medicine (Baltimore) ; 99(28): e21009, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664105

RESUMO

OBJECT: To explore the feasibility and practicability of making virtual three-dimensional model of skull defect and customizing titanium implant by skull three-dimensional CT examination of low dose. METHODS: Sixty patients with skull defects who underwent skull three-dimensional CT before cranioplasty were randomly divided into 4 groups: group A (conventional dose 120 peak Kilovoltage (kVp), 150 tube current time product (mAs)), low dose group B (120 kVp, 50 mAs), low dose group C (100 kVp, 50 mAs), low dose group D (100 kVp, 30 mAs). After the scanning, we compared radiation doses and image quality among the groups. The CT data were sent to the reconstruction company to produce accurate titanium implants, and neurosurgeons performed cranioplasty. After the operation, patients immediately underwent head CT scans to confirm the accuracy of the implantation position, and a series of clinical functions were evaluated. RESULTS: There were significant differences in dose length product (DLP) and effective dose (ED) among the 4 groups (P < .001). The volume CT dose index (CDTIvol), DLP, and ED in group D were, respectively, 87.1%, 86.9%, and 87.3% lower than those in group A (P < .001). All images quality were at or above the general level, and there was no statistical difference (P > .05). Titanium implants were successfully manufactured, every cranioplasty was carried out smoothly, and the clinical function of patients recovered well. CONCLUSION: Customizing titanium implant with three-dimensional CT imaging of low dose in skull not only met the clinical requirements, but also significantly reduced the radiation dose and hazard.


Assuntos
Desenho Assistido por Computador , Imageamento Tridimensional , Desenho de Prótese/métodos , Crânio/cirurgia , Titânio , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Método Simples-Cego , Crânio/efeitos da radiação , Adulto Jovem
4.
Medicine (Baltimore) ; 99(28): e21035, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664110

RESUMO

BACKGROUND: One of the most common complications following autologous cranioplasty is bone flap resorption (BFR). Severe BFR can lead to revision surgery with implantation of synthetic bone flap and also necessarily lead to higher hospital expenses. This study aims to perform a meta-analysis to summarize available evidence regarding risk factors of BFR requiring a second surgery in patients with autologous cranioplasty. METHODS: Cohort, case-control, and cross-sectional studies that report the incidence and risk factors of BFR among patients with autologous cranioplasty, published in English, will be considered for selection. Three databases from inception to May 2020 will be searched. The process of data selection, quality assessment, and data extraction will be assessed by 2 authors independently. The study quality will be assessed by Newcastle-Ottawa Scale (NOS) and Agency for Healthcare Research and Quality checklist.The statistical analysis of this meta-analysis will be calculated by Review manager version 5.3. RESULTS: The results of this systematic review and meta-analysis will be disseminated through academic conferences and expected to publish in a peer-reviewed journal CONCLUSION:: This study will offer high-quality evidence about risk factors for BFR after autologous cranioplasty. REGISTRATION NUMBER: INPLASY202050063.


Assuntos
Reabsorção Óssea/epidemiologia , Metanálise como Assunto , Complicações Pós-Operatórias/epidemiologia , Projetos de Pesquisa , Crânio/cirurgia , Retalhos Cirúrgicos , Revisões Sistemáticas como Assunto , Autoenxertos , Transplante Ósseo , Estudos de Casos e Controles , Estudos de Coortes , Estudos Transversais , Humanos , Incidência , Fatores de Risco
7.
J Craniofac Surg ; 31(5): 1186-1190, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32634133

RESUMO

INTRODUCTION: Endoscope-assisted craniectomy and spring-assisted cranioplasty with post-surgical helmet molding are minimally invasive alternatives to the traditional craniosynostosis treatment of open cranial vault remodeling. Families are often faced with deciding between techniques. This study aimed to understand providers' practice patterns in consulting families about surgical options. METHODS: An online survey was developed and distributed to 31 providers. The response rate was 84% (26/31). RESULTS: Twenty-six (100%) respondents offer a minimally invasive surgical option for sagittal craniosynostosis, 21 (81%) for coronal, 20 (77%) for metopic, 18 (69%) for lambdoid, and 12 (46%) for multi-suture. Social issues considered in determining whether to offer a minimally invasive option include anticipated likelihood of compliance (23 = 88%), distance traveled for care (16 = 62%) and financial considerations (6 = 23%). Common tools to explain options include verbal discussion (25 = 96%), 3D reconstructed CT scans (17 = 65%), handouts (13 = 50%), 3D models (12 = 46%), hand drawings (11 = 42%) and slides (10 = 38%). Some respondents strongly (7 = 27%) or somewhat (3 = 12%) encourage a minimally invasive option over open repair. Others indicate they remain neutral (7 = 27%) or tailor their approach to meet perceived needs (8 = 31%). One (4%) somewhat encourages open repair. Despite this variation, all completely (17 = 65%), strongly (5 = 19%) or somewhat agree (4 = 15%) they use shared decision making in presenting surgical options. CONCLUSION: This survey highlights the range of practice patterns in presenting surgical options to families and reveals possible discrepancies in the extent providers believe they use shared decision making and the extent it is actually used.


Assuntos
Craniossinostoses/cirurgia , Crânio/cirurgia , Adulto , Idoso , Craniossinostoses/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Encaminhamento e Consulta , Tomografia Computadorizada por Raios X , Adulto Jovem
9.
J Vis Exp ; (159)2020 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-32510490

RESUMO

Technological advancements in surgical planning and patient-specific implants are constantly evolving. One can either adopt the technology to achieve better results, even in the less experienced hand, or continue without it. As technology develops and becomes more user-friendly, we believe it is time to allow the surgeon the option to plan his/her operations and create his/her own patient-specific surgical guides and fixation plates allowing him full control over the process. We present here a protocol for 3D planning of the operation followed by 3D planning and printing of surgical guides and patient-specific fixation implants. During this process we use two commercial computer-assisted design (CAD) software. We also use a fused deposition modeling printer for the surgical guides and a selective laser sintering printer for the titanium patient-specific fixation implants. The process includes computed tomography (CT) imaging acquisition, 3D segmentation of the skull and facial bones from the CT, 3D planning of the operations, 3D planning of patient-specific fixation implant according to the final position of the bones, 3D planning of surgical guides for performing an accurate osteotomy and preparing the bone for the fixation plates, and 3D printing of the surgical guides and the patient-specific fixation plates. The advantages of the method include full control over the surgery, planned osteotomies and fixation plates, significant reduction in price, reduction in operation duration, superior performance and highly accurate results. Limitations include the need to master the CAD programs.


Assuntos
Desenho Assistido por Computador , Face/cirurgia , Impressão Tridimensional , Próteses e Implantes , Desenho de Prótese , Procedimentos Cirúrgicos Reconstrutivos , Face/diagnóstico por imagem , Feminino , Humanos , Masculino , Osteotomia , Crânio/diagnóstico por imagem , Crânio/cirurgia , Tomografia Computadorizada por Raios X
10.
Plast Reconstr Surg ; 146(4): 833-841, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32590513

RESUMO

BACKGROUND: Spring-assisted surgery is an accepted alternative to cranial vault remodeling for treatment of sagittal craniosynostosis. The long-term safety and efficacy profiles of spring-assisted surgery have not been established. METHODS: This study is a retrospective examination of all patients treated with spring-assisted surgery (n = 175) or cranial vault remodeling (n = 50) for sagittal craniosynostosis at the authors' institution from 2003 to 2017. Data collected included demographic and operative parameters, preoperative and postoperative Cephalic Indices, and complications. Whitaker grades were assigned blindly by a craniofacial surgeon not involved in patients' care. RESULTS: The mean age at surgery was significantly lower for the spring-assisted surgery group compared with the cranial vault remodeling group (4.6 months versus 22.2 months; p < 0.001). Even when combining spring placement with spring removal operations, total surgical time (71.1 minutes versus 173.5 minutes), blood loss (25.0 ml versus 111.2 ml), and hospital stays (41.5 hours versus 90.0 hours) were significantly lower for the spring-assisted surgery cohort versus the cranial vault remodeling group (p < 0.001 for all). There were no differences in infection, reoperation rate, or headaches between the groups. The percentage improvement in Cephalic Index was not significantly different at 1 (p = 0.13), 2 (p = 0.99), and 6 (p = 0.86) years postoperatively. At 12 years postoperatively, the spring-assisted surgery group had persistently improved Cephalic Index (75.7 preoperatively versus 70.7 preoperatively). Those undergoing spring-assisted surgery had significantly better Whitaker scores, indicating less need for revision surgery, compared with the cranial vault remodeling group (p = 0.006). CONCLUSION: Compared with the authors' cranial vault remodeling technique, spring-assisted surgery requires less operating room time and is associated with less blood loss, but it has equivalent long-term Cephalic Indices and subjectively better shape outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Craniossinostoses/cirurgia , Crânio/cirurgia , Humanos , Lactente , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
13.
Oral Maxillofac Surg ; 24(4): 423-429, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32592098

RESUMO

PURPOSE: The purpose of our study was to improve the minor asymmetries of fronto-orbital advancement (FOA) by introducing a simple model to guide the FOA in unicoronal synostosis which may help saving time and cost. METHODS: A retrospective analysis of 16 consecutive patients with unicoronal synostosis corrected by FOA guided by a guide model. Patients with syndromic craniosynostosis or associated craniofacial anomalies were excluded from the analysis. In all cases, 3D mirror image models were used for guiding unilateral fronto-orbital advancement. Demographic, perioperative, and follow-up data were collected for comparison. Cranial and orbital volumes were documented preoperatively and postoperatively and compared with the non-synostotic side. The postsurgical appearance of the face was documented photographically and then evaluated and scored using the Whitaker scoring system. RESULTS: The study included nine males and seven females. The mean age of the patients at the time of the operation was 20.4 months. The mean follow-up duration was 36 months. Mean operative time was 170 min, mean anesthetic time was 230 min, mean blood loss was 50-80 ml, and the average hospital stay was 4.4 days. No relapse that required surgical correction was reported. There were improvements in the orbital indices and volume to be near equal to the normal side. Excellent to good results were obtained in all patients according to the Whitaker classification system. CONCLUSION: Residual deformity after FOA mandates another tool to optimize the results. Our study introduced a simple, easy, and applicable method to guide the FOA with lesser asymmetries.


Assuntos
Craniossinostoses , Procedimentos Cirúrgicos Reconstrutivos , Craniossinostoses/diagnóstico por imagem , Craniossinostoses/cirurgia , Feminino , Humanos , Lactente , Masculino , Órbita/diagnóstico por imagem , Órbita/cirurgia , Impressão Tridimensional , Estudos Retrospectivos , Crânio/cirurgia , Resultado do Tratamento
14.
J Craniofac Surg ; 31(5): 1312-1317, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32569055

RESUMO

PURPOSE: Open cranial vault remodeling (CVR) with autologous split calvarial bone grafts redistributes and recontours an abnormal calvarium to create an expanded cranial vault in patients with craniosynostosis. We report a 12-year retrospective review of 162 nonsyndromic patients who underwent operative repair using our previously-described technique which portends excellent surgical outcomes and can be applied to patients of any age group and with any variety of suture fusion. METHODS: Data was gathered on patients who underwent CVR from 2005 to 2016. Surgical records for each patient were analyzed and included operative time, estimated blood loss, and intraoperative transfusion volumes. Intraoperative and postoperative complications, the need for revision surgery, postoperative length of stay, and follow-up records were also reviewed. Syndromic patients were excluded, as well as patients with incomplete data sets. Patients who underwent either anterior or posterior vault remodeling were compared. RESULTS: A total of 162 patients were included in this case series. Patients undergoing anterior CVR were significantly older than those undergoing posterior CVR (13.3 versus 11.0 months, P < 0.015) and also had significantly greater intraoperative red blood transfusion volumes (20.3 versus 15.3cc/kg, P < 0.0207) and longer operative time than posterior CVR patients (274.9 versus 216.7 minutes, P < 0.0001). No patients required reoperation for resorption or recurrence or persistent contour irregularities. There were no visual or neurological complications. Calvarial bone was successfully split in 100% of cases. CONCLUSIONS: This surgical approach to CVR results in good surgical outcomes with a low recurrence rate, while also maximizing operative efficiency, and minimizing total blood loss and transfusion volume. This technique can be applied to any affected suture in a patient with craniosynostosis and in patients of any age group.


Assuntos
Craniossinostoses/cirurgia , Transfusão de Sangue , Humanos , Lactente , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos , Reoperação , Estudos Retrospectivos , Crânio/cirurgia , Resultado do Tratamento
15.
World Neurosurg ; 140: 267-270, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32428721

RESUMO

BACKGROUND: Tuberculosis is a common disease; however, the prevalence of calvarial tuberculosis is very rare. Most cases of calvarial tuberculosis occur in young patients. We report a rare case of calvarial tuberculosis in an elderly patient. CASE DESCRIPTION: An 89-year-old woman presented with a forehead skin defect. Radiologic imaging showed bony erosion 20 × 10 mm in size with adjacent dural enhancement in the left frontal bone. The patient underwent surgical treatment. Pathology revealed chronic granulomatous inflammation with caseous necrosis, consistent with tuberculosis. Antituberculous medications were prescribed for 6 months. CONCLUSIONS: A careful assessment should be performed to obtain an appropriate diagnosis in cases of osteolytic lesions of the skull.


Assuntos
Dermatopatias/etiologia , Crânio/patologia , Tuberculose Osteoarticular/complicações , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Feminino , Humanos , Dermatopatias/tratamento farmacológico , Dermatopatias/patologia , Dermatopatias/cirurgia , Crânio/cirurgia , Tuberculose Osteoarticular/tratamento farmacológico , Tuberculose Osteoarticular/patologia , Tuberculose Osteoarticular/cirurgia
16.
J Craniofac Surg ; 31(5): e445-e448, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32371683

RESUMO

Hemangiomas are benign vascular lesions characterized by endothelial vascular proliferation and may demonstrate aggressive clinical features. Intraosseous hemangiomas are uncommon and the maxillary location rare, with few cases described in the literature. The treatment of these lesions varies, however they have a better prognosis when a surgical treatment through resection is performed. The aim of this study is to report a case of right maxillary cavernous intraosseous hemangioma treated by surgical resection with previous embolization. The diagnosis was made through incisional biopsy and immunohistochemical examination. An aggressive lesion profile was observed through the Ki67 marker. During surgery, a temporary ipsilateral external carotid artery ligation was performed to minimize possible bleeding. Weber-Fergson surgical access was performed and total surgical resection through hemi-maxillectomy. The patient is stable after 30 months of follow-up without relapses. In suspected cases of intraosseous hemangiomas, accurate diagnosis and total surgical resection of the lesion is essential. The use of therapeutic mammoths that minimize sagging during and after the procedure such as embolization and arteriography should always be performed.


Assuntos
Hemangioma Cavernoso/cirurgia , Neoplasias Maxilares/cirurgia , Crânio/anormalidades , Coluna Vertebral/anormalidades , Malformações Vasculares/cirurgia , Craniotomia , Embolização Terapêutica , Hemangioma Cavernoso/diagnóstico por imagem , Humanos , Masculino , Neoplasias Maxilares/diagnóstico por imagem , Crânio/diagnóstico por imagem , Crânio/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Malformações Vasculares/diagnóstico por imagem , Adulto Jovem
17.
BMC Med Genet ; 21(1): 90, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370745

RESUMO

BACKGROUND: ERF-related craniosynostosis are a rare, complex, premature trisutural fusion associated with a broad spectrum of clinical features and heterogeneous aetiology. Here we describe two cases with the same pathogenic variant and a detailed description of their clinical course. CASE PRESENTATION: Two subjects; a boy with a BLSS requiring repeated skull expansions and his mother who had been operated once for sagittal synostosis. Both developed intracranial hypertension at some point during the course, which was for both verified by formal invasive intracranial pressure monitoring. Exome sequencing revealed a pathogenic truncating frame shift variant in the ERF gene. CONCLUSIONS: Here we describe a boy and his mother with different craniosynostosis patterns, but both with verified intracranial hypertension and heterozygosity for a truncating variant of ERF c.1201_1202delAA (p.Lys401Glufs*10). Our work provides supplementary evidence in support of previous phenotypic descriptions of ERF-related craniosynostosis, particularly late presentation, an evolving synostotic pattern and variable expressivity even among affected family members.


Assuntos
Craniossinostoses/genética , Predisposição Genética para Doença , Hipertensão Intracraniana/genética , Proteínas Repressoras/genética , Adulto , Craniossinostoses/complicações , Craniossinostoses/patologia , Craniossinostoses/cirurgia , Feminino , Heterozigoto , Humanos , Lactente , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/patologia , Hipertensão Intracraniana/cirurgia , Masculino , Mães , Crânio/patologia , Crânio/cirurgia
18.
Nat Protoc ; 15(6): 1992-2023, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32405052

RESUMO

Cranial microsurgery is an essential procedure for accessing the brain through the skull that can be used to introduce neural probes that measure and manipulate neural activity. Neuroscientists have typically used tools such as high-speed drills adapted from dentistry to perform these procedures. As the number of technologies available for neuroscientists has increased, the corresponding cranial microsurgery procedures to deploy them have become more complex. Using a robotic tool that automatically performs these procedures could standardize cranial microsurgeries across neuroscience laboratories and democratize the more challenging procedures. We have recently engineered a robotic surgery platform that utilizes principles of computer numerical control (CNC) machining to perform a wide variety of automated cranial procedures. Here, we describe how to adapt, configure and use an inexpensive desktop CNC mill equipped with a custom-built surface profiler for performing CNC-guided microsurgery on mice. Detailed instructions are provided to utilize this 'Craniobot' for performing circular craniotomies for coverslip implantation, large craniotomies for implanting transparent polymer skulls for cortex-wide imaging access and skull thinning for intact skull imaging. The Craniobot can be set up in <2 weeks using parts that cost <$1,500, and we anticipate that the Craniobot could be easily adapted for use in other small animals.


Assuntos
Craniotomia/instrumentação , Microcirurgia/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Crânio/cirurgia , Animais , Craniotomia/métodos , Desenho de Equipamento , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microcirurgia/métodos , Procedimentos Cirúrgicos Robóticos/métodos
19.
World Neurosurg ; 139: 445-452, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32387405

RESUMO

Cranioplasty is a common neurosurgical procedure performed to reconstruct cranial defects. The materials used to replace bone defects have evolved throughout history. Cranioplasty materials can be broadly divided into biological and synthetic materials. Biological materials can be further subdivided into autologous grafts, allografts, and xenografts. Allografts (bony materials and cartilage from cadavers) and xenografts (bony materials from animals) are out of favor for use in cranioplasty because of their high rates of infection, resorption, and rejection. In autologous cranioplasty, either the cranial bone itself or bones from other parts of the body of the patient are used. Synthetic bone grafts have reduced the operation time and led to better cosmetic results because of the advancement of computer-based customization and three-dimensional printing. Aluminum was the first synthetic bone graft material used, but it was found to irritate neural tissue, induce seizures, and dissolve over time. Acrylic, in the form of methyl methacrylate, is the most widely used material in cranioplasty. Hydroxyapatite is a natural component of bone and is believed to enhance bone repair, resulting in decreased tissue reactions and promoting good osteointegration. Polyetheretherketones are light and nonconductive and do not interfere with imaging modalities. The complication rates of cranioplasty are high, and surgical site infection is the most common complication. The effect of cranioplasty timing on cognitive function remains debatable. However, the timing of cranioplasty is independent of neurologic outcomes. In this article, the history, materials, complications, and evolution of current practices used in cranioplasty are comprehensively reviewed.


Assuntos
Craniotomia , Procedimentos Cirúrgicos Reconstrutivos , Crânio/cirurgia , Humanos
20.
J Craniofac Surg ; 31(5): 1400-1403, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32472896

RESUMO

Improvised explosive device blast injuries frequently report at our center and showed the maximum amount of contamination and damage, both in the facial soft tissues and the skeletal tissues with impregnation of splinters with size ranging from 2 mm to 10 mm. Should splinters be always explored is questionable and varies with every case. The reconstruction in such cases was done with titanium mini-plates along with extensive use of local vascular flaps for soft tissue repair in majority of the cases. Soldier who sustained splinter injuries wrt orbital floor were managed with splinter exploration using C-arm and orbital floor reconstruction using titanium mesh.


Assuntos
Traumatismos por Explosões/cirurgia , Traumatismos Faciais/cirurgia , Crânio/cirurgia , Humanos , Militares , Crânio/lesões
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