Skeletal volume enhancement: implants and osteotomies

Current Opinion in Otolaryngology & Head and Neck Surgery
Shane Zim

Abstract

Facial plastic surgeons are concerned with improving or restoring function and form. Most surgeons perform primarily soft tissue procedures, which alone are often sufficient. However, deficiencies in the underlying craniomaxillofacial skeleton must also be addressed. Facial skeletal augmentation remains an essential aspect of cosmetic and reconstructive surgery. This article reviews the basic alloplastic biomaterials available for facial volume enhancement, discusses the zygomatic sandwich osteotomy for malar augmentation, and describes recent applications of distraction osteogenesis in the craniomaxillofacial region. An update in tissue engineering and computer modeling is also provided. High-porosity expanded polytetrafluoroethylene has been developed to provide a softer feel with less shrinkage and migration because of better biointegration and cellular ingrowth. Long-term results with porous polyethylene have demonstrated superior biocompatibility and minimal complications. Hydroxyapatite cement has been associated with an immunoguided delayed inflammatory reaction that leads to thinning of the overlying skin and exposure of the implant.Applications of distraction osteogenesis are rapidly expanding and include deformities o...Continue Reading

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