Long-term clinical outcome analysis of poly-methyl-methacrylate cranioplasty for large skull defects.
OBJECTIVE
The goal of secondary cranioplasty is permanent cerebral protection in an esthetically acceptable fashion. Reconstruction of cranial defects can be performed with several different materials. Alloplastic materials, such as preformed methyl-methacrylate (PMMA) cranioplasties, are an alternative frequently used at our institution. This retrospective analysis was designed to review the outcomes of PMMA cranioplasty for skull defect reconstruction.


METHODS
Seventy consecutive patients who had 78 PMMA cranioplasties placed from 2003 through 2010 were identified. Mechanism of injury, location of cranioplasty, type of original repair, postoperative complications, and follow-up time were reviewed.


RESULTS
Of the 70 patients, 6 patients had failure and removal of their original PMMA cranioplasty and reinsertion of another, and 2 patients had failure and removal of 2 cranioplasties with replacement of a third, creating a total of 78 PMMA cranioplasties placed. The predominant mechanism of injury was trauma (64%). The most frequent postoperative complication was infection (13%). With the exception of the 2 patients with implant exposure, no patients reported an unacceptable cosmetic result. An overall complication rate of 24% was seen.


CONCLUSIONS
The results of previous studies have shown that infection and complication rates of cranioplasties accomplished with bone cement are substantially higher, that titanium-based implants may obscure follow-up imaging for tumor patients, and that the outcomes regarding hydroxyapatite-based ceramics, although similar to PMMA, are associated with a much higher cost. PMMA remains a cost-effective and proven method to repair cranial defects that fulfills the goals of cranial reconstruction for skull defects.
Division of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, Dallas, TX 75390-9109, USA.
Joby
J
Jaberi
Kenneth
K
Gambrell
Paul
P
Tiwana
Chris
C
Madden
Rick
R
Finn
D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000737:chemistry*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000601:surgery; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010294:Parietal Bone / Q000601:surgery; D019904:Polymethyl Methacrylate / Q000737:chemistry*; D011183:Postoperative Complications; D019736:Prostheses and Implants; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D016459:Prosthesis-Related Infections / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D012086:Reoperation; D012886:Skull / Q000293:injuries / Q000601:surgery*; D013530:Surgical Wound Infection / Q000601:surgery; D013701:Temporal Bone / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
D001672:Biocompatible Materials; D019904:Polymethyl Methacrylate