Porous polyethylene implants in facial reconstruction: Outcome and complications * Angela Ridwan-Pramana a, b, c, * , Jan Wolff a, c , Ashkan Raziei a, d , Claire E. Ashton-James a, d , Tymour Forouzanfar a, c a Department of Oral and Maxillofacial Surgery/Oral Pathology (Head: Prof. T. Forouzanfar), VU University Medical Center, Amsterdam, The Netherlands b Department of Maxillofacial Prosthodontics, Center for Special Care in Dentistry, Amsterdam, The Netherlands c 3D Innovation Lab, VU University Medical Center, Amsterdam, The Netherlands d Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands article info Article history: Paper received 21 August 2014 Accepted 17 June 2015 Available online xxx Keywords: Porous polyethylene Medpor ® Craniofacial reconstruction Complication abstract The aim of the present study was to assess the indications, results and complications of patients treated with porous polyethylene (Medpor ® ) implants in the Department of Oral and Maxillofacial Surgery of VU Medical Centre, Amsterdam over 17 years. A total of 69 high-density porous polyethylene implants (Medpor ® Biomaterial; Porex Surgical, Newman, GA) were used in forty patients (22 males, 18 females). All patients were analysed for gender, age, diagnosis, indications for surgery, follow-up period and postoperative complications. A mean age of 34.1 years was observed. The main reason for implant surgery was post-traumatic functional impairment (27.5%). Most implants were placed at the mandibular angel and the orbital floor. Unsatisfactory appearance scored the highest in postoperative complications (10.1%) followed by infection rate (7.2%). Comparing the number of implants placed over the years and the incidence of complications, makes the overall complications rate of porous polyethylene very low. A consensus about antibiotic prophylaxis is needed. The objective measurements in patient satisfaction and proper implant design would be of great use. © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. 1. Introduction The planning of reconstructive surgeries for complex craniofa- cial defects challenges even the most experienced surgeons (Rudman et al., 2011). Craniofacial defects can be a result of trauma, malformations, or iatrogenic surgical defects. The zygoma and orbit are particularly vulnerable to injury due to their central position in the face (Eski et al., 2007; Menderes et al., 2004). Improper treat- ment of the zygomatico-orbital area results in loss of malar pro- jection, enophthalmos, and dystopia (Eski et al., 2007). An orbit floor defect can lead to diplopia, limitation of ocular movement, infra-orbital numbness, enophthalmos, and reduced vision (Gosau et al., 2011; Ram et al., 2010). In most cases, craniofacial surgery is performed to improve anatomical functioning (e.g., vision). How- ever, the anatomic structure of these regions is also critical to facial aesthetics. Hence, patient satisfaction with treatment depends not only on the restoration of function, but also on the aesthetic results of surgery. It is therefore important to evaluate the aesthetic as well as the functional and clinical results of using different implant materials in craniofacial reconstructive surgery. Craniofacial reconstruction is performed by using onlay grafting with autogenous material or alloplastic implants (Eski et al., 2007; Menderes et al., 2004). The benefits of using autogenous material include relative resistance to infection, relative ease of incorpora- tion into new bone, absence of a foreign body reaction, and a decreased incidence of extrusion (O'Connell et al., 2015). However, there are important disadvantages to using autogenous bone grafts, including unpredictable resorption, displacement problems, donor- site morbidity, and prolonged surgical time (Cenzi et al., 2005; Frodel and Lee, 1998; Lin et al., 2007; Ozturk et al., 2005; Ram et al., 2010). Use of alloplastic implants is shown to be associated with low morbidity rates, but this is site and material dependent (Menderes et al., 2004). * There are no sources of support in the form of grants. * Corresponding author. VU University Medical Center, Department of Oral and Maxillofacial Surgery/Oral Pathology, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Tel.: þ31 20 444 1023; fax: þ31 20 444 1005. E-mail address: a.ridwan@vumc.nl (A. Ridwan-Pramana). Contents lists available at ScienceDirect Journal of Cranio-Maxillo-Facial Surgery journal homepage: www.jcmfs.com http://dx.doi.org/10.1016/j.jcms.2015.06.022 1010-5182/© 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. Journal of Cranio-Maxillo-Facial Surgery xxx (2015) 1e5 Please cite this article in press as: Ridwan-Pramana A, et al., Porous polyethylene implants in facial reconstruction: Outcome and complications, Journal of Cranio-Maxillo-Facial Surgery (2015), http://dx.doi.org/10.1016/j.jcms.2015.06.022