Cranial reconstruction with computer generated hard-tissue replacement patient matched implants: Indications, surgical technique, and long-term follow-up

The aim of this clinical study vas to evaluate the effectiveness and safety of using computer-generated alloplastic (hard-tissue replacement) implants for the reconstruction of large defects of tile upper craniofacial region. Fourteen patients who had large (> 150 cm(2)) preexisting defects of tile cranium or cranio-orbital region underwent surgical reconstruction. Preoperatively, a three-dimensional computed tomographic scan was obtained from which an anatomic model was fabricated. Tile defect in the model was then used to create an alloplastic (hard tissue-replacement polymer) implant for reconstruction and surgical placement. At tile time of surgery,, the implant vas secured into position with either metal or resorbable fixation. In cases where tire frontal sinus was in proximity to tile implant, the frontal sinus was either cranialized and covered with a pericranial flap or obliterated with hydroxyapatite cement. in cases that had been previously irradiated or infected, wide bony debridement and coverage With a vascularized muscle was initially performed, followed by implant reconstruction 6 months later-All implants fit easily into the bone defects, and only four (29 percent) required some minor adjustments to Complete tile fit. All patients healed uneventfully. With a minimum of I year follow-up (average, 3 years) in all cases, excellent contours have been maintained and all patients have remained infection-free. In large cranial defects, custom implants fabricated from porous, hydrophilic hardtissue replacement polymer provide an exacting anatomic fit and a solid stable reconstruction. This method of reconstruction in these defects is rapid and exact, and significantly reduces operative time. Critical attention must be paid, however, to management of tile frontal sinus and preexisting bone infection and the quality of the overlying soft-tissue cover.