Application of Tissue Expander and Carbonated Calcium Phosphate Bone Cement (Norian CRS) in Facial Cleft Reconstruction

摘要

Bone substitute material has been used to reconstruct large craniofacial defect. The application of this material in orbital reconstruction is still limitedly reported, especially for correction of congenital anomalies. We report a case of a patient with Tessier number 3 facial cleft managed using Norian CRS~R (craniofacial repair system), which is composed of monocalcium phosphate, monohydrate, [alpha]-tricalcium phosphate, and calcium carbonate. Orbital and facial reconstruction were done in staged surgery using carbonated calcium phosphate bone cement (Norian CRS~R) for bony reconstruction, combined with tissue expander for soft tissue repair. The result was satisfactory, with improvement of facial and orbital symmetry. No infection or secondary depression was found on the reconstructed site. In facial cleft, the structural and reconstruction of complex craniofacial bony defects may pose challenges for plastic surgeons to achieve good aesthetic result. Effective treatment should provide soft tissue correction without damaging adjacent soft tissues, bone correction to achieve proper form and function with predictable results and minimal complication. The condition is more difficult for secondary cases with deficiency and scarring of surrounding soft tissue. Bone graft is usually utilized to correct the bony defect. However, donor site morbidity, graft absorption, limited quantities, and unpredictable remodeling of the graft still render the final outcome. Bone substitute material, carbonated calcium phosphate bone cement, has been used to reconstruct large craniofacial defect. It has the advantage of unlimited availability and can be easily incorporated into the defect. The application of this material in orbital reconstruction especially for congenital anomaly such as facial cleft is still limitedly reported.