title: Aesthetic outcome in patients after polymethyl-methacrylate (PMMA) cranioplasty - a questionnaire-based single-centre study.
abstract: OBJECTIVE
  Acquired skull deformities are common and most likely treated surgically by cranioplasty. Since data on patient aesthetic outcome after cranioplasty are rare in literature, we aimed to assess patient satisfaction after polymethyl-methacrylate (PMMA)  cranioplasty in this study using a questionnaire.
  
  
  METHODS
  A patient questionnaire was developed to evaluate the grade of satisfaction after surgery. After approval by the institutional ethical review board, we were allowed to send to all 115 patients, who received a cranioplasty  from 2001 to 2008 at the University Hospital of Zurich, our questionnaire once to retrospectively analyze the patient response together with the patient hospital records.
  
  
  RESULTS
  Out of 115 patients, 36 patients were lost to follow-up and our questionnaire was sent out once to 79  patients. Sixty-three of 79 patients replied to the questionnaire (79·7%) and 16 did not reply. Seventeen declined to participate in this study and out of the remaining 46 patients (58·2%, 18 women, mean age 54 years, range 20-83 years), who agreed to participate in this  study, 22 (47·8%) judged their cranioplasty to be aesthetically 'excellent', 16 (34·8%) 'favorable' and 4 (8·7%) 'poor'. Another four patients (8·7%) were not satisfied, asking for a surgical revision. Patient age and gender was  not related to the assessment of the aesthetic result. A higher satisfaction grade was found in patients with primary PMMA cranioplasty compared to PMMA cranioplasty implanted during a second surgery (Fisher's exact test, P = 0·031). A dent was strongly associated  with absence of satisfaction (P<0·01, Fisher's exact test).
  
  
  CONCLUSIONS
  Our questionnaire was suitable to assess patient satisfaction after cranioplasty. Localization of cranioplasty showed to be an important factor of aesthetic outcome, especially in the fronto-temporal  region where a carefully planned reconstruction should be performed to guarantee an excellent grade of satisfaction after surgery.
authors.affiliation: Department of Neurosurgery, University Hospital, University of Zurich, Switzerland.
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Fischer
authors.forename: Jan-Karl
authors.initials: JK
authors.lastname: Burkhardt
authors.forename: Johannes
authors.initials: J
authors.lastname: Sarnthein
authors.forename: René Ludwig
authors.initials: RL
authors.lastname: Bernays
authors.forename: Oliver
authors.initials: O
authors.lastname: Bozinov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019904:Polymethyl Methacrylate / Q000627:therapeutic use*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012886:Skull / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019904:Polymethyl Methacrylate