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Semin Plast Surg 2009; 23(2): 119-131
DOI: 10.1055/s-0029-1214164
© Thieme Medical Publishers

Reconstruction of Osteomyelitis Defects of the Craniofacial Skeleton

Gary E. DeCesare1 , Frederic W-B. Deleyiannis1 , Joseph E. Losee1
  • 1Division of Pediatric Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Publication History

Publication Date:
30 April 2009 (online)

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ABSTRACT

Osteomyelitis of the craniofacial skeleton closely resembles osteomyelitis elsewhere in the body in its pathophysiology and medical management; subsequent reconstruction after debridement remains distinctly challenging. The goals of reconstruction must include the restoration of the complex and readily visible morphology of the cranium and face, as well as the adequate return of vital sensory, expressive, and digestive functions. In this article, the various reconstructive modalities will be discussed including pedicled and nonpedicled flaps with or without an osseous component, nonvascularized bone grafts, alloplastic implants, and bone regeneration using protein therapy. Although reconstruction of craniofacial defects after osteomyelitis commonly proves formidable, the satisfactory return of form and function remains a plausible reconstructive goal.

KEYWORDS

Osteomyelitis - reconstruction - craniofacial - skull - mandible - midface - head and neck

REFERENCES

  • 1 Nelaton A. Elements De Pathologie Chirurgicale. Paris, France; Germer-Bailliere 1844-1859
    Google Scholar
  • 2 David D J, Cooter R D. Craniofacial infection in 10 years of transcranial surgery.  Plast Reconstr Surg. 1987;  80 213-225
    PubMedGoogle Scholar
  • 3 Fearon J A, Yu J, Bartlett S P, Munro I R, Chir B, Whitaker L. Infections in craniofacial surgery: a combined report of 567 procedures from two centers.  Plast Reconstr Surg. 1997;  100 862-868
    CrossrefPubMedGoogle Scholar
  • 4 Barker II F G. Efficacy of prophylactic antibiotics for craniotomy: a meta-analysis.  Neurosurgery. 1994;  35 484-490 discussion 491-482
    CrossrefPubMedGoogle Scholar
  • 5 Verbon A, Husni R N, Gordon S M, Lavertu P, Keys T F. Pott's puffy tumor due to Haemophilus influenzae: case report and review.  Clin Infect Dis. 1996;  23 1305-1307
    PubMedGoogle Scholar
  • 6 Babu R P, Todor R, Kasoff S S. Pott's puffy tumor: the forgotten entity. Case report.  J Neurosurg. 1996;  84 110-112
    PubMedGoogle Scholar
  • 7 Guillen A, Brell M, Cardona E, Claramunt E, Costa J M. Pott's puffy tumour: still not an eradicated entity.  Childs Nerv Syst. 2001;  17 359-362
    CrossrefPubMedGoogle Scholar
  • 8 Tessier P, Kawamoto H, Posnick J, Raulo Y, Tulasne J F, Wolfe S A. Taking calvarial grafts, either split in situ or splitting of the parietal bone flap ex vivo: tools and techniques. V: a 9650-case experience in craniofacial and maxillofacial surgery.  Plast Reconstr Surg. 2005;  116 54S-71S discussion 92S-94S
    CrossrefPubMedGoogle Scholar
  • 9 Gosain A K. Biomaterials for reconstruction of the cranial vault.  Plast Reconstr Surg. 2005;  116 663-666
    CrossrefPubMedGoogle Scholar
  • 10 Manson P N, Crawley W A, Hoopes J E. Frontal cranioplasty: risk factors and choice of cranial vault reconstructive material.  Plast Reconstr Surg. 1986;  77 888-904
    CrossrefPubMedGoogle Scholar
  • 11 Hanssen A D, Spangehl M J. Practical applications of antibiotic-loaded bone cement for treatment of infected joint replacements.  Clin Orthop Relat Res. 2004;  79-85
    PubMedGoogle Scholar
  • 12 Patel M F, Langdon J D. Titanium mesh (Timesh) osteosynthesis: a fast and adaptable method of semi-rigid fixation.  Br J Oral Maxillofac Surg. 1991;  29 316-324
    CrossrefPubMedGoogle Scholar
  • 13 Joffe J M, Aghabeigi B, Davies E H, Harris M. A retrospective study of 66 titanium cranioplasties.  Br J Oral Maxillofac Surg. 1993;  31 144-148
    CrossrefPubMedGoogle Scholar
  • 14 Janecka I P. New reconstructive technologies in skull base surgery: role of titanium mesh and porous polyethylene.  Arch Otolaryngol Head Neck Surg. 2000;  126 396-401
    CrossrefPubMedGoogle Scholar
  • 15 Rubin J P, Yaremchuk M J. Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature.  Plast Reconstr Surg. 1997;  100 1336-1353
    CrossrefPubMedGoogle Scholar
  • 16 Malis L I. Titanium mesh and acrylic cranioplasty.  Neurosurgery. 1989;  25 351-355
    PubMedGoogle Scholar
  • 17 Mottaran R, Guarda-Nardini L, Fusetti S, Ferroneto G, Salar G. Reconstruction of a large post-traumatic cranial defect with a customized titanium plaque.  J Neurosurg Sci. 2004;  48 143-147
    PubMedGoogle Scholar
  • 18 Wu C T, Lee S T, Chen J F, Lin K L, Yen S H. Computer-aided design for three-dimensional titanium mesh used for repairing skull base bone defect in pediatric neurofibromatosis type 1. A novel approach combining biomodeling and neuronavigation.  Pediatr Neurosurg. 2008;  44 133-139
    CrossrefPubMedGoogle Scholar
  • 19 Eppley B L, Morales L, Wood R et al.. Resorbable Plla-Pga plate and screw fixation in pediatric craniofacial surgery: clinical experience in 1883 patients.  Plast Reconstr Surg. 2004;  114 850-856 discussion 857
    CrossrefPubMedGoogle Scholar
  • 20 Fearon J A, Munro I R, Bruce D A. Observations on the use of rigid fixation for craniofacial deformities in infants and young children.  Plast Reconstr Surg. 1995;  95 634-637 discussion 638
    CrossrefPubMedGoogle Scholar
  • 21 Nadol Jr J B. Histopathology of Pseudomonas osteomyelitis of the temporal bone starting as malignant external otitis.  Am J Otolaryngol. 1980;  1 359-371
    PubMedGoogle Scholar
  • 22 Rowlands R G, Lekakis G K, Hinton A E. Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy.  J Laryngol Otol. 2002;  116 556-558
    PubMedGoogle Scholar
  • 23 Dudkiewicz M, Livni G, Kornreich L, Nageris B, Ulanovski D, Raveh E. Acute mastoiditis and osteomyelitis of the temporal bone.  Int J Pediatr Otorhinolaryngol. 2005;  69 1399-1405
    Google Scholar
  • 24 Prasad K C, Prasad S C, Mouli N, Agarwal S. Osteomyelitis in the head and neck.  Acta Otolaryngol. 2007;  127 194-205
    Google Scholar
  • 25 Newman J, O'Malley Jr B W, Chalian A, Brown M T. Microvascular reconstruction of cranial base defects: an evaluation of complication and survival rates to justify the use of this repair.  Arch Otolaryngol Head Neck Surg. 2006;  132 381-384
    Google Scholar
  • 26 Hanasono M M, Utley D S, Goode R L. The temporalis muscle flap for reconstruction after head and neck oncologic surgery.  Laryngoscope. 2001;  111 1719-1725
    CrossrefPubMedGoogle Scholar
  • 27 Clauser L, Curioni C, Spanio S. The use of the temporalis muscle flap in facial and craniofacial reconstructive surgery: a review of 182 cases.  J Craniomaxillofac Surg. 1995;  23 203-214
    CrossrefPubMedGoogle Scholar
  • 28 Chang D W, Langstein H N, Gupta A et al.. Reconstructive management of cranial base defects after tumor ablation.  Plast Reconstr Surg. 2001;  107 1346-1355 discussion 1356-1347
    Google Scholar
  • 29 Disa J J, Rodriguez V M, Cordeiro P G. Reconstruction of lateral skull base oncological defects: the role of free tissue transfer.  Ann Plast Surg. 1998;  41 633-639
    Google Scholar
  • 30 McGuckin M, Goldman R, Bolton L, Salcido R. The clinical relevance of microbiology in acute and chronic wounds.  Adv Skin Wound Care. 2003;  16 12-23
    CrossrefPubMedGoogle Scholar
  • 31 Pusic A L, Chen C M, Patel S, Cordeiro P G, Shah J P. Microvascular reconstruction of the skull base: a clinical approach to surgical defect classification and flap selection.  Skull Base. 2007;  17 5-15
    Google Scholar
  • 32 el-Toukhy E, Szal M, Levine M R, Levine H L. Osteomyelitis of the orbit.  Ophthal Plast Reconstr Surg. 1997;  13 68-71
    PubMedGoogle Scholar
  • 33 Auluck A. Maxillary necrosis by mucormycosis. a case report and literature review.  Med Oral Patol Oral Cir Bucal. 2007;  12 E360-E364
    PubMedGoogle Scholar
  • 34 Kaur A, Kant S, Bhasker S K. Periorbital tuberculosis.  Orbit. 2007;  26 39-42
    CrossrefPubMedGoogle Scholar
  • 35 Munir N, Jones N S. Rhinocerebral mucormycosis with orbital and intracranial extension: a case report and review of optimum management.  J Laryngol Otol. 2007;  121 192-195
    PubMedGoogle Scholar
  • 36 Futran N D, Mendez E. Developments in reconstruction of midface and maxilla.  Lancet Oncol. 2006;  7 249-258
    CrossrefPubMedGoogle Scholar
  • 37 Cordeiro P G, Santamaria E. A classification system and algorithm for reconstruction of maxillectomy and midfacial defects.  Plast Reconstr Surg. 2000;  105 2331-2346 discussion 2347-2338
    CrossrefPubMedGoogle Scholar
  • 38 Futran N D. Primary reconstruction of the maxilla following maxillectomy with or without sacrifice of the orbit.  J Oral Maxillofac Surg. 2005;  63 1765-1769
    CrossrefPubMedGoogle Scholar
  • 39 Cordeiro P G, Disa J J. Challenges in midface reconstruction.  Semin Surg Oncol. 2000;  19 218-225
    CrossrefPubMedGoogle Scholar
  • 40 Garibaldi D C, Iliff N T, Grant M P, Merbs S L. Use of porous polyethylene with embedded titanium in orbital reconstruction: a review of 106 patients.  Ophthal Plast Reconstr Surg. 2007;  23 439-444
    CrossrefPubMedGoogle Scholar
  • 41 Yaremchuk M J. Facial skeletal reconstruction using porous polyethylene implants.  Plast Reconstr Surg. 2003;  111 1818-1827
    CrossrefPubMedGoogle Scholar
  • 42 Lee H B, Hong J P, Kim K T, Chung Y K, Tark K C, Bong J P. Orbital floor and infraorbital rim reconstruction after total maxillectomy using a vascularized calvarial bone flap.  Plast Reconstr Surg. 1999;  104 646-653
    CrossrefPubMedGoogle Scholar
  • 43 Chen C M, Cordeiro P G. The tongue-in-groove technique for orbital floor reconstruction after maxillectomy.  Plast Reconstr Surg. 2008;  121 225-232
    CrossrefPubMedGoogle Scholar
  • 44 Cordeiro P G, Santamaria E, Kraus D H, Strong E W, Shah J P. Reconstruction of total maxillectomy defects with preservation of the orbital contents.  Plast Reconstr Surg. 1998;  102 1874-1884 discussion 1885-1877
    CrossrefPubMedGoogle Scholar
  • 45 Santamaria E, Cordeiro P G. Reconstruction of maxillectomy and midfacial defects with free tissue transfer.  J Surg Oncol. 2006;  94 522-531
    CrossrefPubMedGoogle Scholar
  • 46 Wald E R. Risk factors for osteomyelitis.  Am J Med. 1985;  78 206-212
    CrossrefPubMedGoogle Scholar
  • 47 Koury M, Ellis III E. Rigid internal fixation for the treatment of infected mandibular fractures.  J Oral Maxillofac Surg. 1992;  50 434-443 discussion 443-434
    CrossrefPubMedGoogle Scholar
  • 48 Klotch D W, Prein J. Mandibular reconstruction using AO plates.  Am J Surg. 1987;  154 384-388
    CrossrefPubMedGoogle Scholar
  • 49 Freitag V, Hell B, Fischer H. Experience with AO reconstruction plates after partial mandibular resection involving its continuity.  J Craniomaxillofac Surg. 1991;  19 191-198
    CrossrefPubMedGoogle Scholar
  • 50 Shockley W W, Weissler M C, Pillsbury H C. Immediate mandibular replacement using reconstruction plates.  Arch Otolaryngol Head Neck Surg. 1991;  117 745-749 discussion 750
    PubMedGoogle Scholar
  • 51 Zhe C, Tingchun W. Reconstruction of mandibular defects with composite autologous iliac bone and freeze-treated allogeneic rib grafts.  J Oral Maxillofac Surg. 1982;  40 29-33
    PubMedGoogle Scholar
  • 52 deFries H O. Reconstruction of the mandible: use of combined homologous mandible and autologous bone.  Otolaryngol Head Neck Surg. 1981;  89 694-697
    PubMedGoogle Scholar
  • 53 Marx R E. Mandibular reconstruction.  J Oral Maxillofac Surg. 1993;  51 466-479
    PubMedGoogle Scholar
  • 54 Cordeiro P G, Disa J J, Hidalgo D A, Hu Q Y. Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients.  Plast Reconstr Surg. 1999;  104 1314-1320
    CrossrefPubMedGoogle Scholar
  • 55 Thoma A, Khadaroo R, Grigenas O et al.. Oromandibular reconstruction with the radial-forearm osteocutaneous flap: experience with 60 consecutive cases.  Plast Reconstr Surg. 1999;  104 368-378 discussion 379-380
    CrossrefPubMedGoogle Scholar
  • 56 Shenaq S M, Klebuc M J. The iliac crest microsurgical free flap in mandibular reconstruction.  Clin Plast Surg. 1994;  21 37-44
    PubMedGoogle Scholar
  • 57 Einhorn T A. Clinical applications of recombinant human BMPs: early experience and future development.  J Bone Joint Surg Am. 2003;  85(Suppl 3) 82-88
    PubMedGoogle Scholar
  • 58 Baskin D S, Ryan P, Sonntag V, Westmark R, Widmayer M A. A prospective, randomized, controlled cervical fusion study using recombinant human bone morphogenetic protein-2 with the cornerstone-Sr allograft ring and the Atlantis anterior cervical plate.  Spine. 2003;  28 1219-1225 discussion 1225
    CrossrefPubMedGoogle Scholar
  • 59 Boyne P J, Lilly L C, Marx R E et al.. De novo bone induction by recombinant human bone morphogenetic protein-2 (rhBMP-2) in maxillary sinus floor augmentation.  J Oral Maxillofac Surg. 2005;  63 1693-1707
    CrossrefPubMedGoogle Scholar
  • 60 Herford A S, Boyne P J. Reconstruction of mandibular continuity defects with bone morphogenetic protein-2 (rhBMP-2).  J Oral Maxillofac Surg. 2008;  66 616-624
    CrossrefPubMedGoogle Scholar
  • 61 Boyne P J, Nakamura A, Shabahang S. Evaluation of the long-term effect of function on rhBMP-2 regenerated hemimandibulectomy defects.  Br J Oral Maxillofac Surg. 1999;  37 344-352
    CrossrefPubMedGoogle Scholar

Joseph E LoseeM.D. F.A.C.S. F.A.A.P. 

Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh

University of Pittsburgh, 3705 Fifth Avenue, DeSoto Wing, G437, Pittsburgh, PA 15213-2583

Email: Joseph.losee@chp.edu

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