scholarly journals Comparison of two different titanium cranioplasty methods: Custom-made titanium prostheses versus precurved titanium mesh

2020 ◽  
Vol 11 ◽  
pp. 148
Author(s):  
Domenico Policicchio ◽  
Gina Casu ◽  
Giosuè Dipellegrini ◽  
Artan Doda ◽  
Giampiero Muggianu ◽  
...  
Keyword(s):  
Young Patients ◽  
Single Stage ◽  
Mesh Exposure ◽  
Titanium Mesh ◽  
Cosmetic Results ◽  
First Choice ◽  
Custom Made ◽  
Duration Of Surgery ◽  
Custom Made Prostheses ◽  
Titanium Cranioplasty

Background: The aim of this study was to compare the results of two different titanium cranioplasties for reconstructing skull defects: standard precurved mesh versus custom-made prostheses. Methods: Retrospective analysis of 23 patients submitted to titanium cranioplasty between January 2014 and January 2019. Ten patients underwent delayed cranioplasty using custom-made prostheses; and 13 patients were treated using precurved titanium mesh (ten delayed cranioplasties, and three single-stage resection- reconstructions). Demographic, clinical, and radiological data were recorded. Results and complications of the two methods were compared, including duration of surgery, cosmetic results (visual analog scale for cosmesis [VASC]), and costs of the implants. Results: Complications: one epidural hematoma in the custom-made group, one delayed failure in precurved group due to wound dehiscence with mesh exposure. There were no infections in either group. All custom-made prostheses perfectly fitted on the defect; eight of 13 precurved mesh prostheses incompletely covered the defect. Custom-made cranioplasty obtained better cosmetic results (average VASC 94 vs. 68), shorter surgical time (141min vs. 186min), and -fewer screws was needed to fix the prostheses in place (6 vs. 15). However, satisfactory results were obtained using precurved mesh in cases of small defects and in single-stage reconstruction. Precurved mesh was found to be cheaper (€1,500 vs. €5,500). Conclusion: Custom-made cranioplasty obtained better results and we would suggest that this should be a first choice, particularly for young patients with a large cranial defect. Precurved mesh was cheaper and useful for single-stage resection-reconstruction. Depending on the individual conditions, both prostheses have their place in cranioplasty therapies.

scholarly journals Maxillary reconstruction using tunneling flap technique with 3D custom-made titanium mesh plate and particulate cancellous bone and marrow graft: a case report

2019 ◽  
Vol 41 (1) ◽  
Author(s):  
Masayuki Takano ◽  
Keisuke Sugahara ◽  
Masahide Koyachi ◽  
Kento Odaka ◽  
Satoru Matsunaga ◽  
...  
Keyword(s):  
Cancellous Bone ◽  
Reconstructive Surgery ◽  
3D Model ◽  
Bony Defect ◽  
Mesh Exposure ◽  
Titanium Mesh ◽  
Marrow Graft ◽  
Anterior Maxilla ◽  
Flap Technique ◽  
Custom Made

Abstract Background Reconstructive surgery is often required for tumors of the oral and maxillofacial region, irrespective of whether they are benign or malignant, the area involved, and the tumor size. Recently, three-dimensional (3D) models are increasingly used in reconstructive surgery. However, these models have rarely been adapted for the fabrication of custom-made reconstruction materials. In this report, we present a case of maxillary reconstruction using a laboratory-engineered, custom-made mesh plate from a 3D model. Case presentation The patient was a 56-year-old female, who had undergone maxillary resection in 2011 for intraoral squamous cell carcinoma that presented as a swelling of the anterior maxillary gingiva. Five years later, there was no recurrence of the malignant tumor and a maxillary reconstruction was planned. Computed tomography (CT) revealed a large bony defect in the dental-alveolar area of the anterior maxilla. Using the CT data, a 3D model of the maxilla was prepared, and the site of reconstruction determined. A custom-made mesh plate was fabricated using the 3D model (Okada Medical Supply, Tokyo, Japan). We performed the reconstruction using the custom-made titanium mesh plate and the particulate cancellous bone and marrow graft from her iliac bone. We employed the tunneling flap technique without alveolar crest incision, to prevent surgical wound dehiscence, mesh exposure, and alveolar bone loss. Ten months later, three dental implants were inserted in the graft. Before the final crown setting, we performed a gingivoplasty with palate mucosal graft. The patient has expressed total satisfaction with both the functional and esthetic outcomes of the procedure. Conclusion We have successfully performed a maxillary and dental reconstruction using a custom-made, pre-bent titanium mesh plate.

scholarly journals A randomized controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty

2017 ◽  
Vol 126 (1) ◽  
pp. 81-90 ◽  
Author(s):  
Stephen Honeybul ◽  
David Anthony Morrison ◽  
Kwok M. Ho ◽  
Christopher R. P. Lind ◽  
Elizabeth Geelhoed
Keyword(s):  
Controlled Trial ◽  
Secondary Infection ◽  
Young Patients ◽  
Cost Effective ◽  
Secondary Outcome ◽  
Clinical Trial Registration ◽  
Skull Defects ◽  
Custom Made ◽  
Autologous Bone ◽  
Titanium Cranioplasty

OBJECTIVE Autologous bone is usually used to reconstruct skull defects following decompressive surgery. However, it is associated with a high failure rate due to infection and resorption. The aim of this study was to see whether it would be cost-effective to use titanium as a primary reconstructive material. METHODS Sixty-four patients were enrolled and randomized to receive either their own bone or a primary titanium cranioplasty. All surgical procedures were performed by the senior surgeon. Primary and secondary outcome measures were assessed at 1 year after cranioplasty. RESULTS There were no primary infections in either arm of the trial. There was one secondary infection of a titanium cranioplasty that had replaced a resorbed autologous cranioplasty. In the titanium group, no patient was considered to have partial or complete cranioplasty failure at 12 months of follow-up (p = 0.002) and none needed revision (p = 0.053). There were 2 deaths unrelated to the cranioplasty, one in each arm of the trial. Among the 31 patients who had an autologous cranioplasty, 7 patients (22%) had complete resorption of the autologous bone such that it was deemed a complete failure. Partial or complete autologous bone resorption appeared to be more common among young patients than older patients (32 vs 45 years old, p = 0.013). The total cumulative cost between the 2 groups was not significantly different (mean difference A$3281, 95% CI $−9869 to $3308; p = 0.327). CONCLUSIONS Primary titanium cranioplasty should be seriously considered for young patients who require reconstruction of the skull vault following decompressive craniectomy. Clinical trial registration no.: ACTRN12612000353897 (anzctr.org.au)

scholarly journals Immediate Post-Extraction Short Implant Placement with Immediate Loading and without Extraction of an Impacted Maxillary Canine: Two Case Reports

Materials ◽  
2021 ◽  
Vol 14 (11) ◽  
pp. 2757
Author(s):  
José Antonio Moreno-Rodríguez ◽  
Julia Guerrero-Gironés ◽  
Francisco Javier Rodríguez-Lozano ◽  
Miguel Ramón Pecci-Lloret
Keyword(s):  
Dental Implant ◽  
Alveolar Bone ◽  
Case Reports ◽  
Young Patients ◽  
Aesthetic Result ◽  
First Choice ◽  
Surgical Extraction ◽  
Impacted Canine ◽  
Short Implant

For the treatment of impacted maxillary canines, traction associated with a complete orthodontic treatment is the first choice in young patients. However, in adults, this treatment has a worse prognosis. The surgical extraction of the impacted tooth can result in a series of complications and a compromised alveolar bone integrity, which may lead to the requirement of a bone regeneration/grafting procedure to replace the canine with a dental implant. These case reports aimed to describe an alternative treatment procedure to the surgical extraction of impacted maxillary canines in adults. Following clinical and computerized tomography-scan (CT-Scan) examination, the possibility of maintaining the impacted canine in its position and replacing the temporary canine present in its place with a dental implant was planned. A short dental implant with an immediate provisional crown was placed, without contacting the impacted canine. At 3 months follow-up, a definitive metal-ceramic restoration was placed. Follow-up visits were performed periodically. The implant site showed a physiological soft tissue color and firmness, no marginal bone loss, no infection or inflammation, and an adequate aesthetic result in all follow-up visits. These results suggest that the treatment carried out is a valid option to rehabilitate with an osseointegrated short implant area where a canine is included, as long as there is a sufficient amount of the remaining bone.

scholarly journals Managing Titanium Mesh Exposure With Partial Removal of the Exposed Site: A Case Series Study

2017 ◽  
Vol 43 (6) ◽  
pp. 482-490 ◽  
Author(s):  
Aladdin J. Al-Ardah ◽  
Abdulaziz AlHelal ◽  
Periklis Proussaefs ◽  
Bader AlBader ◽  
Abdulakareem A. Al humaidan ◽  
...  
Keyword(s):  
Case Series ◽  
Mesh Exposure ◽  
Titanium Mesh ◽  
Partial Removal ◽  
Exposed Site ◽  
Case Series Study ◽  
Series Study

Limb-salvage reconstruction following resection of pelvic bone sarcomas involving the acetabulum

2021 ◽  
Vol 103-B (4) ◽  
pp. 795-803
Author(s):  
Tomohiro Fujiwara ◽  
Manuel Ricardo Medellin Rincon ◽  
Andrea Sambri ◽  
Yusuke Tsuda ◽  
Rhys Clark ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Major Complication ◽  
Ice Cream ◽  
Pelvic Bone ◽  
Limb Salvage Surgery ◽  
Consecutive Series ◽  
Major Complications ◽  
Custom Made ◽  
The Mean ◽  
Custom Made Prostheses

Aims Limb salvage for pelvic sarcomas involving the acetabulum is a major surgical challenge. There remains no consensus about what is the optimum type of reconstruction after resection of the tumour. The aim of this study was to evaluate the surgical outcomes in these patients according to the methods of periacetabular reconstruction. Methods The study involved a consecutive series of 122 patients with a periacetabular bone sarcoma who underwent limb-salvage surgery involving a custom-made prosthesis in 65 (53%), an ice-cream cone prosthesis in 21 (17%), an extracorporeal irradiated autograft in 18 (15%), and nonskeletal reconstruction in 18 (15%). Results The rates of major complications necessitating further surgery were 62%, 24%, 56%, and 17% for custom-made prostheses, ice-cream cone prostheses, irradiated autografts and nonskeletal reconstructions, respectively (p = 0.001). The ten-year cumulative incidence of failure of the reconstruction was 19%, 9%, 33%, and 0%, respectively. The major cause of failure was deep infection (11%), followed by local recurrence (6%). The mean functional Musculoskeletal Tumour Society (MSTS) scores were 59%, 74%, 64%, and 72%, respectively. The scores were significantly lower in patients with major complications than in those without complications (mean 52% (SD 20%) vs 74% (SD 19%); p < 0.001). For periacetabular resections involving the ilium, the mean score was the highest with custom-made prostheses (82% (SD 10%)) in patients without any major complication; however, nonskeletal reconstruction resulted in the highest mean scores (78% (SD 12%)) in patients who had major complications. For periacetabular resections not involving the ilium, significantly higher mean scores were obtained with ice-cream cone prostheses (79% (SD 17%); p = 0.031). Conclusion Functional outcome following periacetabular reconstruction is closely associated with the occurrence of complications requiring further surgery. For tumours treated with periacetabular and iliac resection, skeletal reconstruction may result in the best outcomes in the absence of complications, whereas nonskeletal reconstruction is a reasonable option if the risk of complications is high. For tumours requiring periacetabular resection without the ilium, reconstruction using an ice-cream cone prosthesis supported by antibiotic-laden cement is a reliable option. Cite this article: Bone Joint J 2021;103-B(4):795–803.

scholarly journals Laparoscopic myotomy in achalasia cardia treatment: Experience after 36 operations

2013 ◽  
Vol 141 (7-8) ◽  
pp. 475-481
Author(s):  
Milos Bjelovic ◽  
Bratislav Spica ◽  
Dragan Gunjic ◽  
Danko Grujic ◽  
Ognjan Skrobic ◽  
...  
Keyword(s):  
Surgical Procedure ◽  
Length Of Hospital Stay ◽  
Oral Feeding ◽  
Time Interval ◽  
Partial Fundoplication ◽  
Laparoscopic Myotomy ◽  
Posterior Aspect ◽  
First Choice ◽  
Duration Of Surgery ◽  
Dor Operation

Introduction. Laparoscopic Heller?Dor operation, a standard method in the treatment of achalasia, has been performed at the Center for Esophageal Surgery of the First Surgical Clinic since April 2006. Objective. The aim of this study was to present this surgical procedure and initial experiences after 36 consecutive laparoscopic Heller?Dor operations. Methods. This partly retrospective, partly prospective study presented our results after laparoscopic Heller?Dor operation (presentation of the treatment method). We performed a standard anterior esophagocardioymiotomy, without releasing the posterior aspect of the cardia, and anterior partial fundoplication. The type and severity of symptoms and their duration were evaluated based on questionnaires fulfilled by patients. The diagnosis was made based on radiological, endoscopic and manometric findings. Laparoscopic surgery as the method of treatment was evaluated based on the duration of surgery, intra? and postoperative complications, time interval until the initiation of oral feeding, length of hospital stay, need for additional therapeutic measures after the operation and effect of surgery on the severity of symptoms. Results. Preopereratively, dysphagia was the predominant symptom in all patients, while regurgitation was much lower (44%). The average duration of operation was 127 minutes. Postoperative hospitalization lasted on the average 5.7 days. From 36 treated patients, 34 (94.4%) considered that the effect of treatment was good or excellent. Postoperative dysphagia was present in two patients (5.6%) and was successfully solved by balloon dilatation. Conclusion. Laparoscopic Heller?Dor operation is an effective and safe surgical procedure in resolving symptoms of achalasia and today presents the method of the first choice in the treatment of this disease.

Load-Bearing Capacity and Design Advantages of a Custom-Made, Thin Pure-Titanium Cranioplasty (CranioTop)

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Marc Lewitz ◽  
Asem Salma ◽  
Heinz Welzel Saravia ◽  
Ioanna Sakellaropoulou ◽  
Hraq Mourad Sarkis ◽  
...  
Keyword(s):  
Bearing Capacity ◽  
Pure Titanium ◽  
Load Bearing Capacity ◽  
Load Bearing ◽  
Custom Made ◽  
Titanium Cranioplasty

Early to medium-term outcomes of uncemented ceramic-bearing total hip arthroplasty in teenagers for paediatric hip conditions

2020 ◽  
Vol 102-B (11) ◽  
pp. 1491-1496
Author(s):  
Pranai K. Buddhdev ◽  
Ivor S. Vanhegan ◽  
Tahir Khan ◽  
Aresh Hashemi-Nejad
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Adolescent And Young Adult ◽  
Medium Term ◽  
Total Hip ◽  
Custom Made ◽  
The Mean ◽  
Custom Made Prostheses

Aims Despite advances in the treatment of paediatric hip disease, adolescent and young adult patients can develop early onset end-stage osteoarthritis. The aims of this study were to address the indications and medium-term outcomes for total hip arthroplasty (THA) with ceramic bearings for teenage patients. Methods Surgery was performed by a single surgeon working in the paediatric orthopaedic unit of a tertiary referral hospital. Databases were interrogated from 2003 to 2017 for all teenage patients undergoing THA with a minimum 2.3 year follow-up. Data capture included patient demographics, the underlying hip pathology, number of previous surgeries, and THA prostheses used. Institutional ethical approval was granted to contact patients for prospective clinical outcomes and obtain up-to-date radiographs. In total, 60 primary hips were implanted in 51 patients (35 female, 16 male) with nine bilateral cases. The mean age was 16.7 years (12 to 19) and mean follow-up was 9.3 years (2.3 to 16.8). Results The most common indication for teenage hip arthroplasty was avascular necrosis secondary to slipped upper femoral epiphysis (31%; n = 16). Overall, 64% of patients (n = 33) had undergone multiple previous operations. The survival at follow-up was 97%; two patients required revision for aseptic loosening (one femoral stem, one acetabular component). Both patients had fused hips noted at the time of arthroplasty. A further two patients had radiolucent lines but were asymptomatic. At latest follow-up the mean Oxford Hip Score was 44 (31 to 48) and a Visual Analogue Scale measurement of 1.5, indicating satisfactory function. Conclusion Operating on this cohort can be complicated by multiple previous surgeries and distorted anatomy, which in some cases require custom-made prostheses. We have demonstrated a good outcome with low revision rate in this complex group of patients. Cite this article: Bone Joint J 2020;102-B(11):1491–1496.

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