J.L. Cebrián

Polyetheretherketone custom-made implants for craniofacial defects: Report of 14 cases and review of the literature

BACKGROUND Craniofacial defects tend to carry functional and esthetic consequences for the patient. The complex shapes in this region make such reconstructions a challenging procedure and the most suitable material to be used remains controversial. METHODS We report a series of 14 patients whose craniofacial defects were reconstructed using a computer designed PEEK-PSI (Polyetheretherketone- Patient Specific Implant). We analyzed the complications and outcomes of PEEK custom-made implants and compared our results with those of other case series reported in the current literature. RESULTS Fourteen patients underwent craniofacial reconstruction using a PEEK-PSI. Three cases involved a one-step primary reconstruction and the rest of cases underwent a delayed reconstruction. Two cases (14.3 %) presented infection and only in one case was the implant definitively removed. Esthetic results were considered to be highly satisfactory. CONCLUSION With CAD-CAM techniques, it is possible to prefabricate an individual implant. The ideal material for reconstructing maxillofacial defects does not exist, but PEEK has demonstrated good outcomes. When autologous bone is not available or, in selected cases with large or complex defects in the maxillofacial area, PEEK is one of the best options to reconstruct these defects. However, further studies are needed to determine the long-term results.

Trastornos hidroelectrolíticos en el postoperatorio de cirugía ortognática

espanolObjetivo. El objetivo de este trabajo es analizar los cuadros de poliuria precoz encontrados en un alto porcentaje de nuestros pacientes sometidos a procedimientos de cirugia ortognatica. Material y metodo. Hemos realizado un estudio descriptivo retrospectivo, a partir de la revision de las historias clinicas de los 172 pacientes sometidos a cirugia ortognatica entre los anos 1997 y 2002, con el fin de recoger datos analiticos y de diuresis referentes tanto a la cirugia como al periodo de estancia en Reanimacion. Resultados. Un 55% de los pacientes que ingresaron en la unidad de reanimacion postoperatoria presentaron poliurias precoces autolimitadas. Todas fueron tratadas con exito con un correcto manejo hidroelectrolitico, salvo un caso que necesito desmopresina intranasal. Dos pacientes presentaron alteraciones ionicas: un caso de hipopotasemia y otro de hiponatremia. Ambos respondieron adecuadamente a la reposicion hidroelectrolitica. Discusion y conclusiones. Casi el 50% de los pacientes tratados de deformidades dentofaciales mediante cirugia ortognatica desarrolla poliuria en el postoperatorio inmediato. Las tres hipotesis etiologicas que barajamos fueron: una intoxicacion hidrica producida en el quirofano, una inhibicion de la produccion hipofisaria de hormona antidiuretica tras las osteotomias faciales y un sindrome de gasto de sal relacionado con excrecion inadecuada del peptido atrial natriuretico. En nuestros casos lo mas probable es que se trate de una intoxicacion hidrica producida durante la cirugia, que haga replantearse el manejo de liquidos en el periodo perioperatorio. EnglishIntroduction. The aim of this article is to analize the early polyuria cases that we found among our patients that have undergone a orthognatic procedure. Materials and methods. We reviewed data from 172 patients that have undergone an orthognatic surgycal procedures between 1997 and 2002. We collected data during the intraoperatory period, and the first 24 postoperatory hours. Results. 55% of the patients that staid for more than 24 hours in Reanimation showed early autolimited polyuria. All of them were successfully treated with a proper hidroelectrolitic treatment. One needed intranasal desmopresin. However hypopotasemy in one case and hyponatremy in another were resolved with hidroelectrolitic treatment. Disscusion and conclusions. Almost 50% of patients surgically treated of dentofacial deformities present polyuria in the early postoperatory period. There are three main etiologic hypotesis: hydric intoxication during surgery, inhibition of ADH liberation due to facial osteotomies, and salt wasting syndrome. The most probable in our serie is an hydric intoxication during surgery.