title: Endoscopic delivery of calcium phosphate cement for secondary craniofacial reconstruction.
abstract: Contour defects are common following primary craniofacial procedures including cranial vault remodeling, fronto-orbital and midface advancements, and complex posttraumatic reconstructions. When onlayed as fast-setting pastes, calcium phosphate cements (CPCs) have been used to effectively correct contour defects in open secondary reconstruction procedures. Here, we describe an endoscopic procedure using an injectable CPC and compare surgical outcomes with the open technique. A retrospective review was conducted for 36 consecutive patients aged 3.0-28.9 years (mean, 10.1 years) who underwent secondary craniofacial reconstruction over a 3-year period. Patients were stratified into endoscopic or open groups depending on the surgical approach utilized. Mean operative time was significantly shorter (P < 0.001) for the endoscopic group (64 minutes) than for the open group (131 minutes). Similarly, hospital stay was significantly shorter (P = 0.005) in the endoscopic group than in the open group. There was also a significant difference with respect to cost (P < 0.001), with the endoscopic approach resulting in a per-patient cost savings of $2208.05. In conclusion, endoscopic delivery of CPC appears to be a safe, efficacious, and cost-effective method of performing secondary craniofacial reconstruction, with the additional benefits of decreased operative time and shorter postoperative hospital stay when compared with an open procedure.
authors.affiliation: Division of Plastic & Maxillofacial Surgery, Children's Hospital Los Angeles, CA, USA.
authors.forename: Cameron S
authors.initials: CS
authors.lastname: Francis
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Wong
authors.forename: Steven R
authors.initials: SR
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D001843:Bone Cements / Q000191:economics / Q000627:therapeutic use*; D002130:Calcium Phosphates / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D019465:Craniofacial Abnormalities / Q000601:surgery*; D004724:Endoscopy / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000191:economics; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001843:Bone Cements; D002130:Calcium Phosphates; C020243:calcium phosphate