Reconstruction of large fronto-orbital defects with Dacron polyurethane custom prosthesis and autogenous bone

Reconstruction of large defects of the frontal bone and bony orbit may be required following trauma or ablative tumor surgery. Autogenous bone or alloplastic implants used alone may prove inadequate due to difficulties obtaining symmetric contours with bone and lack of strength and resistance to infection with alloplastic materials. These problems can be overcome with the combined use of a prefabricated Dacron polyurethane mesh prosthesis (Osteo-Mesh, Xomed, Inc.) to establish contour of the forehead and superciliary ridges, and underlying split-rib grafts to protect the brain and isolate the paranasal sinuses. This technique is not indicated for small frontal defects, but it should be considered for use by the head and neck surgeon who is faced with the challenge of reconstructing a major fronto-orbital defect.