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Custom CAD/CAM implants for complex craniofacial reconstruction in children: Our experience based on 136 cases✰.
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Custom CAD/CAM implants for complex craniofacial reconstruction in children: Our experience based on 136 cases✰.

J Plast Reconstr Aesthet Surg. 2018 Aug 02;:

Authors: Nguyen PD, Khechoyan DY, Phillips JH, Forrest CR

Abstract
BACKGROUND: CAD-CAM patient-specific implants offer cerebral protection and improved facial balance without the disadvantages of autologous bone grafting such as donor site morbidity and unpredictable resorption. Several alloplastic materials are available, but titanium, polymethylmethacrylate (PMMA), and polyetheretherketone (PEEK) are the current popular choices. We reviewed our experience of applying different alloplastic CAD-CAM materials in the reconstruction of complex pediatric craniofacial deformities.
METHODS: A retrospective review was performed of all pediatric patients who underwent a complex inlay or onlay implant craniofacial reconstruction using CAD-CAM PEEK, PMMA, or titanium implants at a single institution. Demographics, cost, operative time, complications, and outcomes were assessed.
RESULTS: Between 2003 and 2014, 136 patients (69 male; 67 female; mean age 11.5 years (3-22 years); mean follow-up 30 months) had custom patient-specific craniofacial reconstruction with PEEK (n = 72), PMMA (n = 42), and titanium (n = 22) implants (inlay = 93; onlay = 43). Indications included congenital anomalies (26.5%), decompressive craniectomies (25.0%), craniofacial syndromes (25.7%), tumor defects (14.0%), and post-trauma (6.6%). Implant cost varied significantly for PEEK ($7703 CAD) and PMMA ($8328 CAD) compared with that for titanium ($11,980 CAD) (p < 0.0005). Six patients (4.4%) required surgery due to infection consisting of irrigation and antibiotic administration with successful implant salvage in three patients. All infections occurred in the PEEK group. Five patients (3.7%) ultimately had implants removed due to infection (n = 3), late exposure (titanium; n = 1), or late fracture (PMMA; n = 1).
CONCLUSIONS: CAD-CAM alloplast reconstruction in the management of complex pediatric craniofacial deformities is effective although expensive. Implant infection does not always require explantation. A reconstruction algorithm is presented.

PMID: 30220563 [PubMed - as supplied by publisher]

Delayed Chronic Subdural Hematoma after Total Cranial Vault Reconstruction for Sagittal Synostosis.
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Delayed Chronic Subdural Hematoma after Total Cranial Vault Reconstruction for Sagittal Synostosis.

Pediatr Neurosurg. 2018;53(3):200-204

Authors: Pasarikovski CR, Abel TJ, Forrest CR, Dirks PB, Ibrahim GM

Abstract
When diagnosed and treated after the first year of life, the surgical management of sagittal synostosis typically necessitates total cranial vault reconstruction. The safety of total cranial vault reshaping has improved greatly over the past 3 decades. We report on the first published case of an asymptomatic 5-year-old patient who was found to have a large left sided chronic subdural hematoma 4 months after total cranial vault reshaping requiring surgery, detected on routine imaging. We hypothesize that augmentation of venous blood egression through the emissary veins during surgery may have led to venous hypertension and subsequently the development of the chronic subdural hematoma.

PMID: 29672313 [PubMed - indexed for MEDLINE]