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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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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½ y after correction of open bite and heavy chin

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LOGO Mandibular angle in asymmetries

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LOGO Mandibular angle in drag king

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3 years postop

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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