Long Term Results of the Reconstruction of Maxillofacial Segmental Bone Defects with Bioactive Glass: Presentation of six cases

摘要

Reconstruction of the maxillofacial bone defects secondary to ablative surgery or because of trauma or congenital defects poses a challenge to the plastic surgeons. These defects can be reconstructed with autologous or synthetic materials. Biomaterials are widely used with success in the reconstruction of the craniofacial skeleton, due to accompanying problems of autogenous bone grafts like the potential donor site morbidity, time consumption, need for experience and possibility of graft resorption in the postoperative period. In this report, we present our experience and long term results in reconstruction of maxillofacial segmental bone defects with bioactive glass (NovaBone, Porex Surgical, Newman, Ga.) in six patients in Adnan Menderes University Hospital, Turkey. The patients were followed for minimum 12 months post-operatively and the process of ossification was checked at 6-month intervals by means of clinical, radiological methods. Radiological examinations demonstrated conversion of the majority of the reconstructed defect to bone density within 6 months, new bone was palpable in first year of the operation. Only one patient was re-operated since her new bone was disrupted secondary to the trauma after first operation. In conclusion, bioactive glass is very suitable material fort the reconstruction of the bone defects in face. To the best of our knowledge the defect in the case with mandibular cyst presented in this report is the largest one which reconstructed with only bioactive glass in the literature. Background Biomaterials are widely used with success in the reconstruction of the craniofacial skeleton, due to accompanying problems of autogenous bone grafts like the potential donor site morbidity, time consumption, need for experience and possibility of graft resorption in the postoperative period. The ideal biomaterial should be biocompatible with the surrounding tissue, radiolucent, easily shaped or molded, strong enough to endure trauma, stable over time, able to maintain volume, and osteoactive [1]. There are many alternatives in biomaterials, and bioactive glass particles are among the relative newest materials and just a few reports are present in the literature about application of bioactive glass. In this report, we present our experience and long term results in reconstruction of maxillofacial segmental bone defects with bioactive glass (NovaBone, Porex Surgical, Newman, Ga.) in six patients. Methods Six patients with maxillofacial segmental bone defects in varying anatomical sites were treated with bioactive glass in Plastic and Reconstructive Surgery Department, Medical Faculty, Adnan Menderes University,Turkey. All patients were followed minimum 12 months maximum 36 months regularly. The process of ossification was checked at 6-month intervals by means of clinical, radiological methods. Radiological examinations demonstrated conversion of the majority of the reconstructed defect to bone density within 6 months, new bone was palpable in end of first year of the operation. Details of the patient were given in Table 1.