Around 60,000 craniofacial reconstructions take place in the UK each year, due to trauma, surgical removal of tumours, or congenital anomalies.
A maxillofacial surgeon’s skill is the primary need, although the materials used in reconstruction play a role. They must be carefully chosen, to prevent issues such as infection, or reduced mobility and because of their properties.
Tensile strength, density and molecular elasticity can matter, alongside avoiding rejection. Autografts, the use of your body’s own tissue such as in bone grafts, are often a good solution.
Your surgeon’s choice is still governed by the type of fracture and the mechanical properties required in each case. Large cranial defects for example may be better dealt with using an alternative.
Standard Options
Various metals have been used in maxillofacial surgery. Vitallium was an early front runner, gold and stainless steel also well tried.
They may have a place in a few cases, perhaps encased in biocompatible alloplastic materials. In general, corrosion issues and their less than perfect structural properties mean they have been succeeded by titanium.
Titanium is more naturally biocompatibile and forms a stable oxide layer on the surface to enhance this point. Additional benefits include reduced allergic reaction, not interfering with scanning equipment and good tensile properties.
An innate ability to support bone growth is a further advantage and where required, titanium mesh can be covered with a material such as polyethylene, to provide a porous surface which encourages tissue growth.
In most cases, implanted material will soon be covered by soft tissue, by nature, a transplant, or flap surgery. There are still situations where the covering will be thin and the implant’s colour could affect aesthetic outcome.
Whilst titanium’s ability to mimic native tissue behaviour and other properties make this a leading, logical choice, there can be times to consider alternatives, both existing and being developed.
Looking Forward
There is already a range of synthetic options which could apply to an individual case. The future is however more exciting and medically fulfilling.
The digital age has brought an ability to create a precise model of a patient’s craniofacial region, in 2D, or 3D. Computer software works alongside a range of scanning techniques, including cone beam computed tomography.
Customised implants can be made to ensure a precise fit, often on machines which are known as 3D printers. They are able to work with a range of materials, including titanium.
Other materials are being developed specifically for 3D printing and building customised facial implants. There are trials on the creation of a scaffold implant, to encourage new bone growth and then be absorbed into the body.
Using your own tissue is a sound choice, apart from perhaps causing discomfort in a fresh area. Titanium is the leader amongst proven materials.
Our maxillofacial surgeons will however look at all options and those coming to fruition. Recreating shape, comfort and functionality for you is the real gold standard of facial trauma surgery and our entire aim.
