5.3. Cranio-maxillofacial reconstruction with coral-derived granules

In study IV of the 36 patients the majority of the 54 augmentation sites involved the frontotemporal region (32 sites, 59.1%). Most of these patients had been treated for pre-existing craniofacial problems, such as craniosynostosis. They therefore required touch-up procedures to treat residual minor bony defects in order to improve on the aesthetics of their surgical outcomes. All the sites in the upper facial skeleton were approached using distant transcutaneous incisions. In the malar region two of the ten sites were treated using an intra-oral approach. All nine maxillary sites and one mandibular site were approached intra-orally.

Table 10 lists the average volume of coral injected at each site. The amounts ranged from 1.0 to 6.0 ml. Small volumes were used because the majority of the corrections were touch-ups in children.

Three types of complications were observed in this series. Prolonged wound inflammation was noted in two patients (3.8% of sites) where coral granules were left inadvertently in the superficial layers of the wound. Inflammation was noted to subside once the granules were removed.

In one case of frank suppuration occurred in a patient who had a frontal bony irregularity resulting from previous trauma. The origin of the infection was a pre-existing perforation of the anterior wall of the frontal sinus, which necessitated removal of all the granules. This was followed by a resolution of the infection.

Resorption was clinically evident in five sites during the one to three-year follow-up period. Two occurred in the same patient who was afflicted with hemifacial atrophy or Rhomberg’s Disease. Three other sites of noticeable resorption occurred in areas where the bony contact with the implanted material was not very good, such as along the thin infraorbital rim. The remaining patients did not show any clinical or radiographic signs of resorption during the follow-up period.