facial contour corrections with calcium hydroxyapatite granules and fibrin sealant maurice mommaerts...
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Facial contour corrections with calcium hydroxyapatite granules and fibrin sealant
Maurice MommaertsPresident European Association for Cranio-Maxillo-Facial Surgery
Bruges, Belgium
7th Asian Pacific Craniofacial conference, Taipeh, Taiwan
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LOGO Issues
Contour irregularities in corrective osteotomies In chin osteotomy In sagittal split osteotomy for mandibular advancement in
skinny ladies
Post trauma & congenital defects Orbital region Temporal areas Localized midfacial deficiency in clefts and craniofacial
syndromes
Residual asymmetries uncorrectable with osteotomies Mandibular border & lateral surface
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LOGO 2003-2008 caseload of 48 patients
14
15
3
6
4
6
0 5 10 15 20
Chin
Jaw angle
Mandibular border
BSSO defect
Paranasalaugmentation
Orbital/temporalregion
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LOGO Combination
Hydroxyapatite
Pro Osteon(Interpore Cross)
Fibrin glue
Tisseel/Tissucol
Bone paste Bone paste
Human Human cancellouscancellousbonebone
Pro OsteonPro OsteonImplant Implant 500500
Blood clotBlood clot
Tisseel clotTisseel clot
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LOGO Sealant
Purified fibrinogen (a protein)Purified thrombin (an enzyme)
derived from human bloodHuman blood factor XIIIAprotinin, derived from cows' lungs
Factor XIII strengthens blood clots by forming cross-links between strands of fibrinAprotinin is a protein that inhibits the enzymes that break down blood clots
Fibrin sealant (FS) Fibrin sealant (FS)
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LOGO Sealant
HemostasisSealingClosing effect
As of 2003, all fibrin sealants used are made from blood plasma taken from carefully screened donors and rigorously tested to eliminate hepatitis viruses, HIV-1, and parvovirus.
Fibrin sealant (FS) Fibrin sealant (FS)
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LOGO Calcium hydroxylapatite
A mineralNaturally occurring form of calcium apatite Ca5(PO4)3(OH
70% of bone is made up of HA
Ability to integrate in bone structures &support bone ingrowth, without breaking down or dissolving (i.e it is bioactive)
Granules (HA) Granules (HA)
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LOGO Application mode 1
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LOGO Application mode 2
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LOGO Chin osteotomy - anterior
text2
anterior step anterior step
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LOGO
1 day postop
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LOGO Chin osteotomy - lateral
lateral step lateral step
+ autologous bone from chin ostectomy
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½ y after correction of open bite and heavy chin
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½ y after correction of open bite and heavy chin
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LOGO
½ y after correction of open bite and heavy chin
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LOGO
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LOGO Mandibular angle in asymmetries
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LOGO
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LOGO Mandibular angle in drag king
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LOGO
3 years postop
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LOGO
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LOGO In facial makeover
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LOGO Infraorbital augmentation
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LOGO Conclusion
“clay” “clay”
no infections no infections
rare tract extrusion rare tract extrusion
long-term results long-term results