title: Cranioplasty of Hemispherical Defects Using Calcium Phosphate Cements Along with Titanium Mesh: Our Experience.
abstract: BACKGROUND
  Cranial defects may arise due to trauma, infection, surgical ablation or errors in development. Restoration of such defects is important for esthetics, function and morale of the patient. Several materials are available. Each has its advantages and disadvantages. Search is on for an ideal material. Autogenous grafts remain the gold standard in reconstruction of such defects. However, the morbidity associated with their harvest, additional time required, the need for a second surgical site and the limited supply has led to the search for newer substitutes. Although many materials are available today including biologic and non biologic substitutes, there is still no consensus about the best material. In this article we describe our use of calcium phosphate cements for reconstruction of hemispherical cranial defects.
  
  
  METHODS
  Cases requiring reconstruction of hemispherical cranial defects (more than 15 cm in any dimension) were selected for study. After exposing the defect under GA, titanium mesh was adapted to the defect for support. Then the calcium phosphate cement was prepared and injected on the mesh to establish good contour. The alloplastic insert in each patient was evaluated for: (a) Immediate post-operative complications (b) Restoration of contour and soft tissue support (c) New bone formation ascertained on HRCT at the end of 2 years. Patients were examined on postoperative first week, at 3 and at 6 months. High resolution computed tomography scans were taken at 2 years postop. There were two female and three male patients.
  
  
  RESULTS
  There were no complications in the post operative period. The general condition of the patients improved post operatively. Even though the cements maintained their contour at 2 years, there were no signs of bone formation within the cement.
  
  
  CONCLUSIONS
  Calcium phosphate cement is a good bone substitute for use in cranioplasty. In defects requiring mechanical strength, it should be supported by a titanium mesh. It retains the contour but is not replaced by bone even after 2 years.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Swami Devi Dyal College, Barwala, Panchkula, Haryana India.
authors.forename: N Girish
authors.initials: NG
authors.lastname: Kumar
authors.affiliation: Department of Maxillofacial Surgery, 16 CDU, C/O 56 APO, Panchkula, India.
authors.forename: S
authors.initials: S
authors.lastname: Sudeep
authors.affiliation: Department of Oral and Maxillofacial Surgery, Swami Devi Dyal College, Barwala, Panchkula, Haryana India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Balwan
keywords: Calcium phosphate cements; Cranioplasty; Decompressive craniectomy; Reconstruction