title: Aesthetic refinement of secondary cranioplasty using methyl methacrylate bone cements.
abstract: BACKGROUND
  Cranioplasty using alternate alloplastic bone substitutes instead of autologous bone grafting is inevitable in the clinical field. The authors present their experiences with cranial reshaping using methyl methacrylate (MMA) and describe technical tips that are keys to a successful procedure.
  
  
  METHODS
  A retrospective chart review of patients who underwent cranioplasty with MMA between April 2007 and July 2010 was performed. For 20 patients, MMA was used for cranioplasty after craniofacial trauma (n = 16), tumor resection (n = 2), and a vascular procedure (n = 2). The patients were divided into two groups. In group 1, MMA was used in full-thickness inlay fashion (n = 3), and in group 2, MMA was applied in partial-thickness onlay fashion (n = 17). The locations of reconstruction included the frontotemporal region (n = 5), the frontoparietotemporal region (n = 5), the frontal region (n = 9), and the vertex region (n = 1). The size of cranioplasty varied from 30 to 144 cm(2).
  
  
  RESULTS
  The amount of MMA used ranged from 20 to 70 g. This biomaterial was applied without difficulty, and no intraoperative complications were linked to the applied material. The patients were followed for 6 months to 4 years (mean, 2 years) after MMA implantation. None of the patients showed any evidence of implant infection, exposure, or extrusion. Moreover, the construct appeared to be structurally stable over time in all the patients.
  
  
  CONCLUSIONS
  Methyl methacrylate is a useful adjunct for treating deficiencies of the cranial skeleton. It provides rapid and reliable correction of bony defects and contour deformities. Although MMA is alloplastic, appropriate surgical procedures can avoid problems such as infection and extrusion. An acceptable overlying soft tissue envelope should be maintained together with minimal contamination of the operative site.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
authors.forename: So-Eun
authors.initials: SE
authors.lastname: Han
authors.forename: So Young
authors.initials: SY
authors.lastname: Lim
authors.forename: Jai-Kyung
authors.initials: JK
authors.lastname: Pyon
authors.forename: Goo-Hyun
authors.initials: GH
authors.lastname: Mun
authors.forename: Sa-Ik
authors.initials: SI
authors.lastname: Bang
authors.forename: Kap Sung
authors.initials: KS
authors.lastname: Oh
mesh_terms: D000293:Adolescent; D000328:Adult; D001843:Bone Cements; D003399:Craniotomy; D005260:Female; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000601:surgery; D008297:Male; D020366:Methylmethacrylate; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D055815:Young Adult
chemical_list: D001843:Bone Cements; D020366:Methylmethacrylate