Custom CAD/CAM implants for complex craniofacial reconstruction in children: our experience based on 136 cases

Publication date: Available online 2 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Phuong D. Nguyen, David Y. Khechoyan, John H. Phillips, Christopher R. Forrest

Abstract

Background

CAD-CAM patient specific implants offer cerebral protection and improved facial balance without the disadvantages of autologous bone such as donor site morbidity and unpredictable resorption. Several alloplastic materials are available but titanium, polymethylmethacrylate (PMMA) and polyetheretherketone (PEEK) are the current popular choices. We reviewed our experience applying alloplastic CAD-CAM materials in the reconstruction of complex pediatric craniofacial deformities.

Methods

A retrospective review was performed of all pediatric patients undergoing complex inlay or onlay implant craniofacial reconstruction using CAD-CAM PEEK, PMMA, or titanium implants at a single institution. Demographics, cost, operative time, complications, and outcomes were assessed.

Results

Between 2003 and 2014, 136 patients (69 male; 67 female; mean age 11.5 years (3 – 22 years); mean follow-up 30 months) had custom patient-specific craniofacial reconstruction with PEEK (n=72), PMMA (n=42) and titanium (n=22) implants (inlay = 93; onlay = 43). Indications included congenital anomalies (26.5%), decompressive craniectomies (25.0%), craniofacial syndromes (25.7%), tumor defects (14.0%), and post-trauma (6.6%). Implant cost varied significantly PEEK ($7,703 CAD) and PMMA ($8,328 CAD) compared with titanium ($11,980 CAD) (p<0.0005). Six patients (4.4%) required surgery due to infection consisting of irrigation and antibiotic administration with successful implant salvage in 3 patients. All infections occurred in the PEEK group. Five patients (3.7%) ultimately had implants removed due to infection (n=3), late exposure (titanium; n=1), or late fracture (PMMA; n=1).

Conclusions

CAD-CAM alloplast reconstruction in the management of complex pediatric craniofacial deformities are effective although expensive. Implant infection does not always require explantation. A reconstructive algorithm is presented.