Cranioplasty of Fronto-orbital Defects

Angled multidimensional configuration of fronto-orbital defects with scar transformation of the soft tissue, closeness of the frontal sinus, forming of subfrontal meningo-, meningoencephalocele requires precise surgical planning for reconstructive surgery of this deformed area using bioinert durable x-ray contrast material and computer-aided 3D design of implants, which makes the problem of fronto-orbital defects particularly real. Materials and Methods: In this study we analyzed 13 patients with post-traumatic fronto-orbital defects. In 4 (31%) cases the frontal sinus was involved. Defects were classified by size on patients (10 to 30 cm3) - 8 (69%) patients, big (30 to 60 cm 2 ) - 4 (31%) cases. Cranioplasty was done within 6 months of the traumatic episode. On the basis of 3D computer tomography scans, we developed a special half-automatic program which calculated all geometric parameters of fronto-orbital osseous defects necessary to fabricate an implant. This was done as a laboratory experiment on 60 rabbits, with comparative estimation of advantages and disadvantages of acrylic, titanium, and corundum implants. Based on the results of the laboratory experiment, we chose corundum implants for cranioplasty of fronto-orbital defects. To all patient external and internal meningolisis were performed, with plastic osseous defects by preoperatively modeled corundum implants. Results and Discussion: All 13 patients were discharged from the hospital in a satisfactory state. Postoperative wounds healed without infectious complications. In 4 (31%) cases local serositis was observed with subgaleal transudation which resolved by repeated local punctures and aspiration. Follow-up control examinations at 6 and 12 months showed no signs of migration of ceramic implants or osteomyelitis. Configuration of the fronto-orbital area and intracranial and orbital compartments was successfully reconstructed.