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The use of hydroxyapatite cement in secondary craniofacial reconstruction
F D Burstein1, S R Cohen, R Hudgins
1Center for Craniofacial Disorders and the Division of Neurosurgery at Scottish Rite Children's Medical Center, Atlanta, GA 30342, USA. FBurstein@aol.com
Insights
Hydroxyapatite cement effectively corrects craniofacial contour defects in pediatric and adult patients. This biomaterial demonstrated excellent implant retention and safety, with no interference in craniofacial growth observed.
Area of Science:
- Biomaterials Science
- Craniofacial Surgery
- Pediatric Plastic Surgery
Background:
- Secondary craniofacial reconstruction addresses contour defects following various surgical interventions and trauma.
- Hydroxyapatite cement is a synthetic bone substitute with osteoconductive properties.
Purpose of the Study:
- To evaluate the safety and efficacy of hydroxyapatite cement for secondary craniofacial contour defect reconstruction in a pediatric and adult cohort.
- To assess implant volume retention, complication rates, and potential interference with craniofacial growth.
Main Methods:
- A retrospective review of 61 patients (56 children, 5 adults) who underwent secondary craniofacial reconstruction using hydroxyapatite cement over a 3-year period.
- Follow-up averaged 20 months, assessing for complications, contour correction, and growth effects.
Main Results:
- Seven complications (11%) occurred, primarily in the initial 18 months, all managed with reoperation without compromising contour correction.
- Excellent implant volume retention was observed, with no recurrence of contour defects.
- No visible interference with craniofacial growth was detected during the study period.
Conclusions:
- Hydroxyapatite cement is a versatile and safe biomaterial for correcting secondary craniofacial contour defects in both children and adults.
- The biomaterial shows promise for applications in osteomyelitis treatment when combined with antibiotics.
Abstract:
Sixty-one patients underwent secondary craniofacial reconstruction for contour defects using hydroxyapatite cement over a 3-year period (20-month mean follow-up). There were 56 children, aged 2.2 to 18 years (mean, 10.7 years), 21 boys and 35 girls. This is the first series of pediatric patients in whom the use of hydroxyapatite cement has been reported. There were five adults aged 21 to 46 years (mean, 32 years), 3 men and 2 women. Thirty-one patients underwent reconstruction for secondary orbitocranial defects after surgery for synostosis, 7 after surgery for hypertelorism, 10 for posttraumatic skull defects, and 13 for a variety of other facial skeletal defects. There were seven complications (11 percent), ranging from a retained drain to postoperative seromas, all of which required reoperation without loss of the contour correction. All of the complications occurred in the first 18 months of our study. There has been excellent retention of implant volume with no recurrence of contour defects to date. We have not found any visible evidence of interference with craniofacial growth over the study period. We conclude that hydroxyapatite cement is a versatile and safe biomaterial when used for the correction of secondary craniofacial contour defects in children and adults. The coupling of antibiotics with this biomaterial may have applications in the treatment of osteomyelitis.