Reconstruction of Craniofacial Bone Defect with Titanium Dynamic Mesh

ABSTRACT

Reconstructing craniofacial bone defect is mainly done by autogenous bone graft and alloplastic implant insertion. Autogenous bone graft has the advantage of supplying the similar tissue to the bone defect area. But, due to several problems arose by using autogenous bone graft, the clinical use of the alloplastic implant has been increased. Among the various implants, titanium mesh has many advantages in chemical and physical properties. We have treated 26 patients with craniofacial bone defects (9 cases of cranium, 17 cases of orbital bone, and 9 cases of maxilla) using the titanium dynamic mesh (Howmedica Leibinger Inc.) and autogenous bone graft together in last two years. We followed up the patients for 3 to 18 months (mean, 8.2 months) and got satisfactory results with low complication rates. We found that the titanium dynamic mesh could be used successfully as an alternative substitute in reconstruction of the small to medium-sized defects in the craniofacial area. To maximize the success, certain surgical techniques had to be used. These techniques are as follow 1.It required expertise to produce complex 3-dimensional contours of the craniofacial bone (frontal eminence, orbital margin etc.) with hand forming techniques. 2.In cranioplasty, at least 4 points fixation and enough soft tissue coverage were necessary. 3.In orbital wall reconstruction, mesh was inserted with the margins rested on the firm surrounding bone after meticulous trimming and molding to minimize complication such as enophthalmos. 4.In maxillary sinus reconstruction, attention was needed to prevent of soft tissue prolapse into the sinus and to aerate of the sinus. In conclusion, the excellent biocompatibility of titanium and easy application of the titanium dynamic mesh are outstanding characteristics in three-dimensional reconstruction of craniofacial bone defect with minimal morbidity and complications.