Application-specific selection of biomaterials for pediatric craniofacial reconstruction: developing a rational...

Biomaterials provide an invaluable alternative to autogenous bone graft for pediatric craniofacial reconstruction. However, there is no uniform agreement on the choice of biomaterial for different reconstructive needs.

Patients who had reconstruction of the craniofacial skeleton with alloplastic materials from 1994 to 2006 by a single surgeon were reviewed. Biomaterials used consisted of three classes: cement pastes, biomaterials designed to be replaced by bone, and prefabricated polymers. The study included 25 patients with a mean age of 5.5 years and a mean follow-up of 3.3 years.

Cement pastes used for onlay augmentation to the cranial skeleton in eight patients consisted of hydroxyapatite (n = 5) and calcium phosphate (n = 3). One patient had a postoperative infection that resolved with partial implant removal and antibiotics. Biomaterials designed to be replaced by bone consisted of bioactive glass (n = 3) and demineralized bone (n = 8), which were used for inlay reconstruction of full-thickness calvarial defects in 11 patients. Computed tomographic scanning showed adequate bone mineralization in nine patients; two of the three patients with calvarial defects greater than 5 cm in diameter demonstrated variable mineralization. Prefabricated porous polyethylene was used in six patients for either onlay malar augmentation (n = 3) or inlay calvarial reconstruction (n = 3). One patient had a peri-implant infection that resolved with aspiration, irrigation, and intravenous antibiotics.

The authors developed an algorithm to guide use of biomaterials in craniofacial reconstruction based on whether (1) growth of the underlying craniofacial skeleton is nearly complete (>90 percent); (2) onlay or inlay reconstruction is to be performed; and (3) the reconstruction is performed in a load-bearing or non-load-bearing area.