Marbacher Serge, Andereggen Lukas, Fandino Javier, Lukes Anton
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
J Craniofac Surg. 2011 Jan;22(1):266-8. doi: 10.1097/SCS.0b013e3181f7b781.
Temporal hollowing due to temporal muscle atrophy after standard skull base surgery is common. Various techniques have been previously described to correct the disfiguring defect. Most often reconstruction is performed using freehand molded polymethylmethacrylate cement. This method and material are insufficient in terms of aesthetic results and implant characteristics. We herein propose reconstruction of such defects with a polyetheretherketone (PEEK)-based patient-specific implant (PSI) including soft-tissue augmentation to preserve normal facial topography. We describe a patient who presented with a large temporo-orbital hemangioma that had been repaired with polymethylmethacrylate 25 years earlier. Because of a toxic skin atrophy fistula, followed by infection and meningitis, this initial implant had to be removed. The large, disfiguring temporo-orbital defect was reconstructed with a PEEK-based PSI. The lateral orbital wall and the temporal muscle atrophy were augmented with computer-aided design and surface modeling techniques. The operative procedure to implant and adopt the reconstructed PEEK-based PSI was simple, and an excellent cosmetic outcome was achieved. The postoperative clinical course was uneventful over a 5-year follow-up period. Polyetheretherketone-based combined bony and soft contour remodeling is a feasible and effective method for cranioplasty including combined bone and soft-tissue reconstruction of temporo-orbital defects. Manual reconstruction of this cosmetically delicate area carries an exceptional risk of disfiguring results. Augmentation surgery in this anatomic location needs accurate PSIs to achieve satisfactory cosmetic results. The cosmetic outcome achieved in this case is superior compared with previously reported techniques.
标准颅底手术后因颞肌萎缩导致的颞部凹陷很常见。此前已描述了各种技术来纠正这种毁容性缺陷。最常用的重建方法是使用徒手塑形的聚甲基丙烯酸甲酯骨水泥。就美学效果和植入物特性而言，这种方法和材料并不理想。我们在此提出用基于聚醚醚酮（PEEK）的定制植入物（PSI）重建此类缺陷，并进行软组织填充以保留正常的面部形态。我们描述了一名患者，其25年前曾用聚甲基丙烯酸甲酯修复过巨大的颞眶部血管瘤。由于出现毒性皮肤萎缩瘘管，随后发生感染和脑膜炎，不得不取出最初的植入物。用基于PEEK的PSI重建了巨大的、毁容性的颞眶部缺损。利用计算机辅助设计和表面建模技术对眶外侧壁和颞肌萎缩进行了填充。植入并采用基于PEEK的重建PSI的手术操作简单，取得了极佳的美容效果。在5年的随访期内，术后临床过程平稳。基于聚醚醚酮的联合骨与软组织轮廓重塑是颅骨成形术的一种可行且有效的方法，包括颞眶部缺损的联合骨与软组织重建。对这个美学要求高的区域进行手工重建会有导致毁容结果的极大风险。在这个解剖位置进行填充手术需要精确的PSI才能获得满意的美容效果。与先前报道的技术相比，该病例取得的美容效果更优。
