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Source publication
Objective:
to present our experience in the surgical treatment of extensive skullcap defects with customized acrylic implants.
Methods:
we conducted a retrospective analysis of patients with extensive skull defects undergoing acrylic cranioplasties between 2004 and 2013. We carefully selected all patients and classified surgical results based on t...
Context in source publication
Context 1
... the patient (6.67%) submitted to acrylic removal, we obtained an excellent craniofacial aesthetic appearance in seven (50%) of the 14 remaining patients. The degree of craniofacial symmetry improvement was considered satisfactory (eight patients -57.14%) or partially satisfactory (six cases -42.86%) and the overall mean of the surgical results classified according to the need for new surgeries was 1.5±0.52, between categories I and II ( Figures 3 and 4 and Table 3). In this series, there ...
Citations
... The implants used in this study were composed of acrylic resin created using a 3D printer. Acrylic resin is used to create dentures and for cranioplasty because of its high biocompatibility [20,21]. In the present study, no abnormalities, such as chronic inflammation, were observed. ...
Simple Summary
The relation between implant components, foreign body reactions to implant materials, and the formation of connective tissue (CNT) in host animals is crucial for developing effective xenotransplantation techniques. This study demonstrated that dairy cows produce several large, dense, collagen-based CNTs following subcutaneous implantation of acrylic resin-based implants. We elucidated the process of CNT formation within the implants. The implants used in this study, comprising an outer cylinder, a core rod, and caps at both ends, were composed of acrylic resin created using a three-dimensional (3D) printer. No abnormalities, such as chronic inflammation, were observed. An advantage of 3D printing technology in the medical field is its ability to produce implants with complex shapes for surgical applications. Therefore, the combination of acrylic resin and 3D printer design holds promise for researching foreign body reaction and clinical applications in future studies.
Abstract
Foreign body reactions (FBRs) are inadvertently observed in invading or artificially embedded materials, triggering inflammation and subsequent fibrotic processes to occur in situ. Here, we assessed the spatiotemporal formation of connective tissue around implanted materials to establish a technique using connective tissue formed by FBRs as xenografts. An acrylic resin implant, comprising a columnar inner rod and a tubular outer cylinder (OC) with several slits, was embedded in adult dairy cows. Tissues formed in the inner rod and OC groups were histologically analyzed at weeks 2, 4, 8, and 12. Edematous tissues with non-collagenous fibers formed for 2 weeks and showed increased cellularity after 4 weeks. The weight, thickness, amounts of total protein, collagen, DNA, and quantitative scores of α-smooth muscle actin-positive myofibroblasts or elastic fibers notably increased after 8 weeks, with condensed collagen fibers showing orientation. Inflammatory cells were primarily localized in tissues close to the OC, and their numbers increased, with the count of CD204+ cells peaking at 8 weeks and declining at 12 weeks. The count of Ki67+ proliferating cells slightly increased in tissues close to the OC; however, the number and lumen of CD31+ vessels increased. These results may help understand FBR-related tissue remodeling.
... The results obtained in the present case emphasize the importance of these techniques for achieving a satisfactory aesthetic resolution. When applicable, autogenous bone grafts are considered the gold standard for cranial reconstructions, however the bioavailability of this type of graft can be an obstacle for major reconstructions, as reported in this case (Da Silva et al., 2017). ...
... In addition to reducing surgical time, digital software allows mirroring of contralateral structures or personalized reconstructions in a virtual environment. The object created for reconstruction can be made (printed or milled) in the grafting material or a negative impression can be used as a template for using the PMMA (Da Silva et al., 2017;Đurić et al., 2019). Inclusion of technologies for planning and making facial skull reconstructions, as observed in the present case, is a reality and should, in the authors' view, be encouraged to optimize clinical results. ...
Anophthalmia is mainly caused by two etiological groups, trauma and medical conditions. In addition, anophthalmia creates difficulties in social, professional, and family adaptation due to psychological, and functional disorders related to eye loss. Studies show a positive influence on the personal relationship of patients with anophthalmia after being rehabilitated with ocular prostheses. However, in order to achieve a good aesthetic result in prosthetic eye rehabilitation, it is essential that the size and positioning of the orbital skeleton are adequate. Facial trauma can also cause defects associated with bone loss, and in these cases, reconstructive techniques aim to restore the appropriate bone contour. The aim of this work is to report a case where reconstructive treatment was performed on a patient victim of a long-term traffic accident sequel, using an alloplastic implant in polymethylmethacrylate (PMMA) and bone repositioning, so that an ocular prosthesis could be made. At the end of the treatment, after reconstruction of the frontal-nasal region in PMMA and repositioning of the left zygoma, the aesthetic objectives were achieved and the patient improved his self-esteem and social life.
... Other notable implant types include those for the humerus, the cranium/skull, and the tibia. [11][12][13][14] . Among all the implants introduced, it should be noted that some are applied as a substitute for bone or scaffold, while others act as additions to support or fix an original bone in the correct position. ...
This report aims to summarize key concerns regarding customized devices and conditional approval during the premarket evaluation of bone implants, and to explore the correlation between them. Based on the experience of approval of the first domestic custom‐designed bone implant, we consider the process of gaining conditional approval for urgently‐needed medical devices and medical devices for rare diseases, as well as the guidance available for clinical investigation. We also streamlined the scientifically administrative concept of this unique device, from the design and development of premarket technical evaluation to continuous post‐market study. The present study found that those two aspects have certain connections, but they are not directly correlated to each other. In contrast to the USA, Canada, Australia and the EU, where regulations and guidelines have been established for the use of customized devices, in this regard, China is still it its infancy. Thus, there is considerable potential for China to develop and perfect the policies relating to customized devices and to develop relevant strategies to ensure their efficacy with the aid of conditional approval. Appropriate scientific conditional approval for mass production of individualized anatomy‐matching bone implants could become a valuable approach for precision medicine.
... The PMMA may be modeled in situ during the surgery or, more recently, tailor-made prosthesis based on 3-dimensional computed tomography images are prepared prior to the cranioplasty, with excellent esthetic results. 10,11 In our service, the use of prototyped prosthesis is rising: 37% of patients who received exclusively PMMA in this sample. ...
Cranioplasty is a common procedure in neurosurgical practice, but associated with high complication rates. In the current study, the authors describe surgical characteristics and results of cranioplasty performed in a tertiary teaching hospital in Brazil. Data were obtained from electronic medical records of cranioplasties performed between January 2013 and November 2016. The sample comprised of 33 patients, and the mean follow-up time was 16 months. Patients presented most of the times a good preoperative status, with 84.8% of patients classified between 0 and 3 at modified Rankin scale and 78.7% with 4 or 5 points at Glasgow Outcome Scale. The most common initial diagnosis was vascular disease (48% of patients) followed by traumatic brain injury (36% of patients). The majority of cranioplasties used an autograft: the autologous bone flap removed during a previous surgery (craniectomy) and stored in the abdominal subcutaneous fat (67% of patients). In 3 patients, the polymethylmethacrylate prosthesis was custom-made prior to the operation using 3-dimensional printing, based on computed tomography images. Five patients (15% of patients) developed symptoms related to surgical site infection, manifesting at an average of 5 weeks following the procedure. Three of them presented scalp dehiscence before the infection symptoms. Cranioplasty should be performed early, as long as clinical conditions are good and the patient has overcome the acute phase of neurological injury.
Objective:
Cranioplasty is one of the oldest known neurosurgical procedure performed. Many materials have been used for cranioplasty since ages. Polymethyl methacrylate (PMMA) has become the workhorse for fabrication of cranial implants since World War II in cases where autologous bone is not available or cannot be harvested. The aim of the present study is to present author's experience in the management of cranioplasty using acrylic implants fabricated using 2 different techniques.
Methods:
The author conducted a retrospective analysis of patients with extensive skull defects undergoing acrylic cranioplasties between October 2016 and January 2018. The surgical results were classified based on surgical time, blood loss, and the 3 scales of patient satisfaction, improvement of facial symmetry, and need for additional surgery along with the rate of wound complications.
Results:
Thirty patients underwent cranioplasty with PMMA-based implants, whether fabricated using alginate impression technique (56.67%) or fabricated using 3-dimensional (3D) printed patient-specific moulds (43.33%). Complications included infection (13.3%). The authors considered the craniofacial aesthetics based on patient satisfaction excellent (69%) with the degree of improvement of craniofacial symmetry satisfactory (92.3%), and 1 patient requiring resurgery in alginate impression technique fabricated implants.
Conclusion:
The author recommends a unique technique for fabrication of PMMA-based implants using 3D printed moulds to achieve a better fitting implant and highly cosmetic outcome for cranioplasty at affordable cost.
Background:
Fat grafting has been described as an option to repair frontotemporal contour deformities (volumetric deficiency of bone and/or soft tissues) after neurosurgical/craniofacial surgical interventions. However, technical surgical descriptions have varied, with reports describing the bolus fat injection or the classical multilayer injection, but with no detailed descriptions concerning how and where the fat should be grafted. The purpose of this study was to assess the frontotemporal symmetry outcomes after a single fat-grafting procedure for postoperative frontotemporal contour deformity reconstructions using the anatomical fat-grafting approach.
Methods:
A prospective analysis was conducted of consecutive patients (n = 106) who underwent anatomical fat grafting (Coleman's structural fat grafting technique using anatomical facial subunit and fat compartment principles) to reconstruct frontotemporal contour deformities after neurosurgical/craniofacial surgical interventions. A subjective assessment by a panel of external surgical professionals and laypersons was obtained to grade the frontotemporal symmetry. Objective ultrasound symmetry assessment was blindly performed preoperatively and at 3- and 12-month follow-up.
Results:
There were significant (all P < 0.05) postoperative subjective and objective frontotemporal symmetry enhancements (preoperative < postoperative) after anatomical fat grafting, with no differences (all P > 0.05) between the 3- and 12-month postoperative comparisons. Thirty-seven percent of patients required an additional fat grafting session for residual asymmetry after 12 months of follow-up.
Conclusions:
Patients with frontotemporal contour deformities presented improved subjective and objective frontotemporal symmetry after an anatomical fat grafting session.
