PolyBone NuroSpine. Cranio-Facial Bone defect * Trauma * Trauma * Surgically induced * Surgically...

PolyBonePolyBone

NuroSpineNuroSpine

Cranio-Facial Bone defectCranio-Facial Bone defect

* Trauma* Trauma * Surgically induced* Surgically induced * Cranio-facial bone tumor* Cranio-facial bone tumor

Awesome to patients & surgeons due to Awesome to patients & surgeons due to cosmetic problemscosmetic problems

Esp) pterional approach (bone defect & Esp) pterional approach (bone defect & delayed temporal m. atrophy)delayed temporal m. atrophy)

PMMA(acryl cement, Resin)PMMA(acryl cement, Resin)

** Most commonly used in Cranio-Facial defect area. Most commonly used in Cranio-Facial defect area.

* Advantages* Advantages

1. Low Price1. Low Price

2. High Mechanical Strength2. High Mechanical Strength

* Disadvantages* Disadvantages

1. May Marked Inflammation Response1. May Marked Inflammation Response

2. Fibrous Encapsulation of Implant2. Fibrous Encapsulation of Implant

-> Possibility of Infection & loosening of implant-> Possibility of Infection & loosening of implant

PMMA(acryl cement, Resin)PMMA(acryl cement, Resin)

* Disadvantages* Disadvantages

3. High temperature (1103. High temperature (11000 C) generated C) generated

-> Tissue damage-> Tissue damage

4. Shaping of Contour of implant after 4. Shaping of Contour of implant after

hardening is difficulthardening is difficult

5. Never convert to Bone5. Never convert to Bone

6. No Bone bonding effect6. No Bone bonding effect

-> Need fixation device (wire, craniofix etc.)-> Need fixation device (wire, craniofix etc.)

Calcium Phosphate CementCalcium Phosphate Cement

Advantages:Advantages: - Biocompatible material- Biocompatible material - Have bone conduction activity- Have bone conduction activity - Easily handling- Easily handling - Good osteointegration- Good osteointegration - Converted to Bone- Converted to Bone

Disadvantages:Disadvantages: - Low tensile strength than PMMA- Low tensile strength than PMMA - Higher cost - Higher cost

PolyBonePolyBone

* Brushite Calcium phosphate Cement(CPC) * Brushite Calcium phosphate Cement(CPC)

-> Convert to bone is fast than other CPC -> Convert to bone is fast than other CPC

* Included Poly-phosphates (Poly-P) : patent* Included Poly-phosphates (Poly-P) : patent

-> Poly-P have bone induction activity-> Poly-P have bone induction activity

-> So, -> So, PolyBonePolyBone have both bone induction have both bone induction

& conduction activity& conduction activity

PolyBonePolyBone

* BoneSource hardening time: 10-20 mins* BoneSource hardening time: 10-20 mins

PolyBone hardening time : within 5 mins PolyBone hardening time : within 5 mins

* Good Bone bonding effect* Good Bone bonding effect

-> No need of fixation device -> No need of fixation device

such as wire or craniofix etcsuch as wire or craniofix etc

..

PolyBonePolyBone

* * Easily making contour during Easily making contour during

application & after hardeningapplication & after hardening

- such as knife, or sharp instrument- such as knife, or sharp instrument

* Augumentation during the procedure* Augumentation during the procedure

is possible (esp. temporal area)is possible (esp. temporal area)

TTipsips If dura was slack down below the inner cortex of If dura was slack down below the inner cortex of

bone margin at the bone defect area, put the bone margin at the bone defect area, put the gelform on the dura at the bone defect area.gelform on the dura at the bone defect area.

-> not to compress the brain by PolyBone-> not to compress the brain by PolyBone

TTipsips

If you anticipated of delayed temporal muscle If you anticipated of delayed temporal muscle atrophy, Augmentation of temporal bone area atrophy, Augmentation of temporal bone area with CPC is possible.with CPC is possible.

TTipsips It is recommended to use each 5 g package It is recommended to use each 5 g package

separated. separated. Well adhesion of new CPC to already hardening Well adhesion of new CPC to already hardening

CPC.CPC.

Application of PolyBone on Application of PolyBone on Craniofacial partCraniofacial part

Reconstruction of cranial defectsReconstruction of cranial defects

-> If larger defect than 10cm-> If larger defect than 10cm22, use of wire , use of wire

mesh is recommended.mesh is recommended.

Closure of frontal sinus openingClosure of frontal sinus opening

Fronto-temporal contouring (Aneurysm Op.)Fronto-temporal contouring (Aneurysm Op.)

Clinical Application on craniofacial area

of PolyBone

Fronto-orbito-zygomatic approachFronto-orbito-zygomatic approach

Onlay grafting for augmentation & Onlay grafting for augmentation &

smoothing contours of skeletal smoothing contours of skeletal

irregularitiesirregularities

MVD Op.MVD Op.

Clinical Application

Augumentaion of nasoglabellar, Augumentaion of nasoglabellar,

supraorbital rim, mandiblesupraorbital rim, mandible

Lateral skull base reconstructionLateral skull base reconstruction

Translabyrinthine approaches & other Translabyrinthine approaches & other

skull base approachskull base approach

Clinical Application

All of these are non-stress-bearing All of these are non-stress-bearing

areas in craniofacial skeletonareas in craniofacial skeleton

Clinical Application

Contraindications of PolyBoneContraindications of PolyBone

Infected fieldInfected field Areas surrounding nonviable boneAreas surrounding nonviable bone Abnormal calcium metabolismAbnormal calcium metabolism Metabolic bone diseasesMetabolic bone diseases Recent untreated infectionRecent untreated infection Poor wound healingPoor wound healing Immunologic abnormalitiesImmunologic abnormalities

BBone Setting CTone Setting CT

X-X-Ray & 3-D CTRay & 3-D CT

Closure of Oro-Antral FistulaClosure of Oro-Antral Fistula

Closure of Frontal Sinus Opening

Closure of Frontal Sinus Opening

Augmentation of temporal area to compensate delayed temporal M.

atrophy

MVD Op

Obliteration of Sella Floor after Trans-Sphenoidal Approach

Clinical Application of

PolyBone (Aneurysm Cases)

KIM, K Y (F/55)

Rt. MCA Aneurysm

KIM, J Y (M/69)

Pericallosal Aneurysm

KIM, T J (F/63)

A-com Aneurysm

PARK, K H (F/59)

P-com Aneurysm MCA Aneurysm

PARK, K H

PARK S D (M/53)

A-com Aneurysm MCA Aneurysm

PARK Y J (F/65)

MCA Aneurysm

PARK Y J

SIN Y S (F/49)

ICA bifurcation Aneurysm

SIN J H (F/74)

P-com Aneurysm

SIN J H

JANG M J (F/58)

MCA Aneurysm

JANG S S (F/67)

MCA Aneurysm A-com Aneurysm

JANG S S

JANG J Y (F/70)

P-com Aneurysm

JEON M J (F/54)

MCA Aneurysm

JEON M J

JEON Y J (F/66)

Lt. MCA Aneurysm Rt. P-com

Aneurysm

Lt. MCA An. OP

JEON Y J

Post- 2nd Op.

Not repaired on Rt. side

HAN S H (F/68)

Pericallosal Aneurysm

Well developed Frontal sinus

Obliteration of opening of the frontal sinus

HWANG Y H (M/43)

MCA Aneurysm

Impact Block type Polybone in Pterion burr hole site

HWANG Y H

YOON M Y (F/60)

A-com Aneurysm