Experience with cranial implant-based prosthetic reconstruction.

Reconstruction of acquired or congenitally absent facial structures is a challenging task for the reconstructive surgeon. Often inadequate soft tissue, cartilaginous, or osseous support exists for a reconstruction which is functional, aesthetic, and achieved with a reasonable effort on the part of the surgeon and patient. Prosthetic reconstruction of these structures utilizing cranial implants is a viable option which offers several advantages when compared to traditional reconstructive techniques. We present our experience with 114 cranial implants in 32 patients for craniofacial reconstruction. One hundred fourteen cranial implants were placed in a total of 32 patients for reconstruction of facial structures. Indications for cranial implants with prosthetic reconstruction were lack of adequate tissue for reconstruction, failed reconstructive attempts, and selection of the technique by the patient. Seventy-two implants were placed in the mastoid region, 31 within the orbit, 7 within the nasal cavity, with four additional implants for the reconstruction of eyebrows. Cranial implants were followed by clinical and radiographic examination at intervals ranging from 3-46 months (mean 15.3 months). Patient records were retrospectively reviewed for surgical complications, soft tissue reactions, infections, and implant failures. The total success rate of cranial implantation in the study group was 92.9% (106/114). Surgical complications occurred in three of the 32 patients (9.3%). All cranial implants were successfully reconstructed after integration. Seven percent of the implants failed after initial integration was successful. The rate of significant soft tissue reactions or frank infection observed among the implanted patients was 6.1%. Titanium cranial implants coupled with custom prosthetic reconstruction offer an excellent alternative to traditional surgical techniques in the reconstruction of acquired or congenitally absent facial structures. Predictability, prosthetic adaptability, as well as superior aesthetics are major advantages to this technique when compared to traditional surgical reconstructive techniques.