Augmentation of facial skeleton with ceramics in congenital disorders and in post-traumatic or postoperative deformities: a preliminary report

The reconstruction of defects of the facial skeleton resulting from congenital faults, tumor removal, or trauma should provide function and form. Synthetic bone substitutes can be used in patients in which autologous bone graft or other operative techniques are contraindicated by the patient’s condition or would not achieve the expected result. The advantages of synthetic substances are obvious: there is no secondary defect due to harvest, and surgery and healing time are therefore reduced. This, together with the shortening of operating and hospital times, reduces costs. A satisfactory result can be achieved in one surgical intervention. Implants are available in the size, volume, and shape required by the anatomical defect; in addition, they are easy to insert, can be stored for long periods, and can be resterilized if necessary. Biocompatible nonresorbable glass ceramics based on oxyfluoroapatite and wollastonite (BAS-0) have been used successfully as a filler or a bone substitute in orthopedics or in maxillofacial surgery since 1991. Surface-active inorganic polycrystalline, nonmetal biomaterial with osteoconductivity, permits osseointegration, i.e., a direct physicochemical bond between live bone tissue and the implant without formation of a fibrous capsule. Compared with hydroxyapatite, it has significantly higher durability to mechanical strain in simulated body fluid and a chemical bond with live bone tissue that is ten- to 100-fold stronger. Due to these features, this material was chosen for restoration of the facial skeletal framework in ten patients in whom other previous solutions had been unsuccessful (contour bone defect with chronic frontal sinusitis developed after open penetrating injury, bone defect after surgery associated with irradiation, significant congenital malformations of the facial skeleton, post-traumatic defects, and postsurgical deformities). The mean time of observation was 6 months. Healing occurred without any adverse reaction or side effect. Two extrusions were solved by secondary surgery. Carefully indicated application of a bone substitute can increase the patient’s quality of life and reduce surgery time and treatment costs.