Chacón-Moya E, Gallegos-Hernández JF, Piña-Cabrales S, Cohn-Zurita F, Goné-Fernández A

Language: Spanish
References: 15
Page: 469-472
PDF size: 115.34 Kb.

ABSTRACT

Background: Reconstruction of the bones of the skull is a complex procedure and represents a challenge for the surgical team. It is generally performed in patients who have loss of the cranial vault secondary to chronic infection or uncontrolled osteorradionecrosis, indicating a greater chance of failure or rejection of the materials used for the repair of the defect. Selection of material to replace the cranial vault is complex due to the diversity of existing products. The ideal material is inert, lightweight, easy-to-fit and adaptable to the defect, offering the best aesthetic and functional results. Computer design of the implant makes this process easier by providing an implant specific to each individual patient and defect. Clinical case: We report the case of a patient who was diagnosed with esthesioneuroblastoma and was treated with anterior craniofacial resection and radiotherapy. Osteomyelitis and osteorradionecrosis were consequent complications with loss of the cranial vault in the f rontal region. The defect was reconstructed with a polyetheretherketone (PEEK) computerdesigned implant based on the defect evaluated by computed tomography. Results obtained are shown below. Conclusions: The PEEK computer-designed implant is a safe, easy-to-use alternative with great adaptability to cranial vault defects.

REFERENCES

1. Shah JP. Skull base surgery: the first 50 years. Eur Arch Otorhinolaryngol.2007;264:711-712.

2. Rivera G, Gallegos HJF, Guinto BG, Cohn ZF, Minauro MGG, Arias CH.Anterior craniofacial resection in centro-facial tumors. Oral Oncol2009(suppl)3;1:101.A-134.

3. 3.Torres A, Acebes JJ, López L, Marnov A, Viñals J, Serra JM, et al. Complications of craniofacial resection in anterior skull base tumors. Neurocirugia 2005;16:492-498.

4. Ganly I, Patel SG, Singh B, Kraus DH, Bridger PG, Cantu G, et al. Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study. Head Neck 2005;27:445-451.

5. Chiu ES, Kraus D, Bui DT, Mehara BJ, Disa JJ, Shah JP, et al. Anterior and middle cranial fossa skull base reconstruction using microvascular free tissue techniques: surgical complications and functional outcomes. Ann Plast Surg 2008;60:514-520.

6. Gómez E, González T, Arias J, Lasaleta L. Three-dimensional reconstruction after removal of zygomatic intraosseous hemangioma. Oral Maxillofac Surg 2008;12:159-162.

7. Rupprecht S, Merten HA, Kessler P, Wilfang J. Hydroxyapatite cement (BoneSource) for repair of critical sized calvarian defects. An experimental study. J Craniomaxillofac Surg 2003;31:149-153.

8. Chepeha DB, Wang SJ, Marentette LJ, Thompson BG, Prince ME, Teknos TN. Radial forearm free tissue transfer complications in salvage skull base surgery. Otolaryngol Head Neck Surg 2004;131:958-963.

9. Pohlenz P, Blessmann M, Heiland M, Blake F, Schmelzle R, Li L. Postoperative complications in 202 cases of microvascular head and neck reconstruction. J Craniomaxillofac Surg 2007;35:311-315.

10. Gallegos-Hernández JF, Martínez-Miramón A. Transplante de peroné para reconstrucción mandibular en pacientes sometidos a mandibulectomía por tumores óseos y de la cavidad bucal. Experiencia de 10 años. Gac Med Mex 2008;144:85-90.

11. Eufinger H, Saylor B. Computer-assisted prefabrication of individual craniofacial implants. AORN J 2001;74:648-654.

12. Scolozzi, P, Martínez A, Jaques B. Complex orbito-fronto-temporal reconstruction using computer-designed PEEK implant. J Craniofac Surg 2007;18:224-228.

13. Schlegel J, Green S. Polyetheretherketones (PEEK). A biocompatible highperformance plastic. Med Plastics 2000;14:12.1-12.10.

14. Baumeister S, Peek A, Friedman A, Levin LS, Marcus JR. Management of postneurosurgical bone flap loss caused by infection. Plast Reconstr Surg 2008;122:195e-208e.

15. Chim H, Schantz JT. New frontiers in calvarial reconstruction: integrating computer-assisted design and tissue engineering in craneoplasty. Plast Reconstr Surg 2005;116:1726-1741.