Reconstruction of anterior frontal wall and contours defects using bone substitute

Luigi Clauser, MD,DMD1, Antonio Lucchi, MD,DMD1, Riccardo Luoni Orsi, DMD1and Carolina Sannino MD1

1 Unit of Maxillo-Facial Surgery, Istituto Stomatologico Italiano, Via Pace, 21, 20122 MILANO, Italy

Aim: The aim of this article is to report on the safety and long-term efficacy of Cerament® BoneVoid Filler bone substitute for repairing craniofacial bone defects. Post-traumatic cranioplasty is a complex and challenging procedure for all maxillo-craniofacial surgeons and neurosurgeons, especially when repairing large areas. The standard criterion  for repairing small cranial defects is the use autogenous bone from the iliac crest or split calvarial grafts. Autogenous grafts may result in donor-site morbidity, increased  surgical time, reabsorption, blood loss, and  longer recovery time . Alloplastic materials used for bone repair, such as methyl methacrylate,  hydroxyapatite, titanium, or porous polyethylene,  are expected to have optimal properties, including easy adaptation, biocompatibility,  ingrowth of new tissue, stability of shape, and low rate of reabsorption. A cranial implant  should be easily shaped and positioned, allowing  easy tissue  growth. In very wide cranium defects the new technology is a custom made cranial implant constructed three-dimensionally  with different types of materials. However, this procedure is very expensive with various infection rates depending on the  kind of material used and on the chemicophysical composition of the implant.

Methods: The authors report the case of a 50-year-old man with a severe deformity of the forehead-supra orbital  area as a result of a previous complex fronto-facial trauma treated in an emergency Unit. Secondary correction and reconstruction of the residual deformities were performed by using Cerament® Bone Void Filler, an  alloplastic biphasic material, composed  of 40% hydroxyapatite, 60% calcium sulfate and the radio-contrast agent iohexol. The unique ratio of hydroxyapatite and calcium sulfate is designed to enable Cerament to resorb at the same rate that bone forms. Calcium sulfate acts as a resorbable carrier for hydroxyapatite which  is highly osteoconductive, promoting bone ingrowth.It seems to be a promising bone graft substitute in the management of bony irregularities in the  fronto-orbital area.

Conclusion: The patient was first hospitalized as the result of a serious craniofacial trauma. One year after the first emergency cranio-orbital reconstructive operation, a marked deformity of the frontal region appeared with a “grid effect” due to the inadequate plate-bony fixation of the fractures applied during the first bony recomposition and because it was not as rigid as it should have been .  A secondary surgery for deformity correction was performed. The hardware was totally removed and the bony deformity smoothed, reshaped, covered and filled using Cerament® Bone Void Filler, a biomaterial. The patient recovered with a satisfactory cranium-forehead shape, no complications, and complete disappearance of a frowning look of the fronto-orbital region.

Recently, increased use of bone substitutes in the reconstruction of bone defects has been fuelled by donor site complications associated with autologous bone harvesting. Cerament® BoneVoid Filler is a biphasic and injectable bone substitute that has a highly compressive strength and the ability to promote cancellous bone healing.

Keywords: Traumatology, fronto-orbital deformity, biomaterials, bone cement, bone grafting, cranioplasty, craniofacial trauma, craniofacial surgery,f rontal sinus, trauma complications

Free Full-text PDF

How to cite this article:

Luigi Clauser, Antonio Lucchi, Riccardo Luoni Orsi, Carolina Sannino. Reconstruction of anterior frontal wall and contours defects using bone substitute. American Journal of Surgical Research and Reviews, 2021, 4:34. DOI:10.28933/ajsrr-2021-09-1807


1. Green AK, Warren S, McCarthy JG. Onlay frontal cranioplasty using wire reinforced methyl methacrylate. J Craniomaxillofac Surg 2008;36:138Y142 doi: 10.1016/j.jcms.2007.05.008.
2. Lykins CL, Friedman CD, Costantino PD, et al. Hydroxyapatite cement in craniofacial skeletal reconstruction and its effects on the developing craniofacial skeleton. Arch Otolaryngol Head Neck Surg 1998;124:153Y159 doi: 10.1001/archotol.124.2.153.
3. David L, Argenta L, Fisher D. Hydroxyapatite cement in pediatric craniofacial reconstruction. J Craniofac Surg 2005;16:129Y133 doi: 10.1097/00001665-200501000-00026
4. Duman H, Deveci M, Uygur F, et al. Reconstruction of contour and anterior wall defects of frontal bone with porous polyethylene implant. J Craniomaxillofac Surg 1999;27:298Y301 DOI: 10.1054/jcms.1999.0902
5. Taghizadeh F, Kromer A, Laedrach K. Evaluation of hydroxyapatite cement for frontal sinus obliteration after mucocele resection. Arch Facial Plast Surg 2006;8:416Y422 · DOI: 10.1001/archfaci.8.6.416
6. Friedman CD, Costantino PD, Synderman CH, et al. Reconstruction of the frontal sinus and frontofacial skeleton with hydroxyapatite cement. Arch Facial Plast Surg 2000;2:124Y129 DOI: 10.1001/archfaci.2.2.124
7. Hofmann et al. ‘Autologous Iliac Bone Graft Compared with Biphasic Hydroxyapatite and Calcium Sulfate Cement for the Treatment of Bone Defects in Tibial Plateau Fractures – A Prospective, Randomized, Open-Label, Multicenter Study.’J Bone Joint Surg Am. 2020;102:179-93. doi: 10.2106/JBJS.19.00680.
8. Nilsson, M. ‘Injectable calcium sulphate and calcium phosphate bone substitutes’. Lund University. 2003. ISBN: 91-628-5603-0.
9. Kaczmarczyk et al. ‘Complete twelve month bone remodeling with a bi-phasic injectable bone substitute in benign bone tumors: a prospective pilot study’. BMC Musculo. Dis. 2015;16:369. doi: 10.1186/s12891-015-0828-3
10. Clauser L. et al.Contouring of the forehead irregularities with Bone material.J Craniomaxillofac. Surg.2012;23:932-934 DOI 10.1097/SCS.0b013e3182505593
11. Hettwer et al. ‘Establishment and effects of allograft and synthetic bone graft substitute treatment of a critical size metaphyseal bone defect model in the sheep femur’. APMIS 2019; 127:53–63. doi: 10.1111/apm.12918

Terms of Use/Privacy Policy/ Disclaimer/ Other Policies:
You agree that by using our site, you have read, understood, and agreed to be bound by all of our terms of use/privacy policy/ disclaimer/ other policies (click here for details)

CC BY 4.0
This work and its PDF file(s) are licensed under a Creative Commons Attribution 4.0 International License.