Cranioplasty using Polymethylmethacrylate (PMMA) self-curing by the conventional casting process: clinical case report

http://dx.doi.org/10.1590/1981-8637201800030000123376 CLÍNICO CLINICAL| |CLINICAL CLÍNICO Cranioplasty using Polymethylmethacrylate (PMMA) self-curing by the conventional casting process: clinical case report Cranioplastia com uso do Polimetilmetacrilato (PMMA) autopolimerizável pelo processo de moldagem convencional: relato de caso clínico Jamil Elias DIB1 ORCID iD 0000-0002-5306-4783 Mario Serra FERREIRA2 ORCID iD 0000-0001-5691-6550 Matheus Branco Elias DIB3 ORCID iD 0000-0002-8982-7519 Wolney Ronaldo Abrahão SILVA4 ORCID iD 0000-0001-5382-4255 Ricardo Guimarães NEVES5 ORCID iD 0000-0003-0415-2645 Érica Miranda de TORRES5 ORCID iD 0000-0002-5544-6865 João Batista de SOUZA5 ORCID iD 0000-0002-7476-9950 ABSTRACT Cranioencephalic trauma which results in extensive edema and / or bruising usually requires surgical treatment through a greater withdrawal of the bone portion. Thus, the absence of bone tissue implies the lack of protection of the brain tissue or even compromises the esthetics especially when located in the frontal or frontoparietal region. The purpose of this case report is to describe a treatment option for head trauma, through the prefabricated part by obtaining the skull model. These bone faults can be reconstructed either by the direct method using polymethylmethacrylate directly on the defects or by means of pre-made pieces such as prototyping or from the skull model. Although other techniques have many good points, some show certain drawbacks, from storage conditions below abdominal fat, preheating due to the release of heat during the high polymerization reaction or the high cost when they are prototyped. The technique described in this work reports its simple performance, eliminating the risk of local heating, allows prior sterilization in autoclave, it is biocompatible, allows perfect anatomical recovery, easy placement, low cost, also highlighs the advantage of the bucomaxillofacial surgeon's performance due to the familiarization with the relevant head and neck procedures. Clinical and tomographic examination after 24 months of treatment showed stability of the polymethylmethacrylate plate, adhesions to the bone margins, and absence of tissue alterations. Indexing terms: Craniectomy. Polymethylmethacrylate. Prosthetics. RESUMO Os traumatismos cranioencefálicos que resultam em extensos edemas e ou hematomas normalmente, requerem tratamentos cirúrgicos por meio de uma retirada maior de porção óssea. Deste modo, a ausência do tecido ósseo implica na falta de proteção do tecido cerebral ou até mesmo comprometer a estética especialmente, quando localizadas na região frontal ou frontoparietal. O objetivo deste relato de caso é descrever uma opção de tratamento para os traumatismos cranioencefálicos, por meio da peça pré-fabricada mediante a obtenção do modelo do crânio. Estas falhas ósseas podem ser reconstruídas tanto pelo método direto utilizando o polimetilmetacrilato diretamente sobre as falhas ou por meio das peças pré-confeccionadas como a prototipagem ou a partir do modelo do crânio. Embora outras técnicas apresentem muitos pontos positivos, algumas mostram determinados inconvenientes, desde condição de armazenamento abaixo da gordura abdominal, aquecimento prévio devido a liberação de calor durante a reação de alto polimerização ou o alto custo quando são prototipadas. A técnica neste trabalho descrita relata sua facilidade de execução, elimina o risco do aquecimento local, permite a prévia esterilização em autoclave, é biocompatível, permite a perfeita recuperação anatômica, fácil colocação, baixo custo, ressaltando ainda a vantagem da atuação do cirurgião bucomaxilofacial devido sua familiarização com os procedimentos pertinentes a cabeça e pescoço. Em exame clínico e tomográfico após 24 meses do tratamento, observa-se estabilidade da placa de polimetilmetacrilato, aderências às margens ósseas, e ausência de alterações tissulares. Termos de indexação: Craniectomia. Polimetilmetacrilato. Próteses. Hospital Estadual de Urgências de Anápolis Dr. Henrique Santillo. Anápolis, GO, Brasil. Centro Universitário de Anápolis Uni Evangélica, Curso de Odontologia. Anápolis, GO, Brasil. 3 Hospital Regional de Ferraz de Vasconcelos Dr. Osiris Florindo Coelho de São Paulo. São Paulo, SP, Brasil. 4 Hospital de Urgências de Anápolis. Anápolis, GO, Brasil. 5 Universidade Federal de Goiás, Programa de Pós-Graduação em Odontologia. Goiânia, GO, Brasil. Correspondência para / Correspondence to: RG NEVES. E-mail: <>. 1 2 ▼ ▼ ▼ ▼ ▼ Como citar este artigo / How to cite this article Dib JE, Ferreira MS, Dib BEM, Silva WRA, Neves RG, Torres EM, et al. Cranioplasty using polymethylmethacrylate (PMMA) self-curing by the conventional casting process: clinical case report. RGO, Rev Gaúch Odontol. 2018;66(3):267-273. http://dx.doi.org/10.1590/1981-8637201800030000123376 RGO, Rev Gaúch Odontol. 2018 Jul-Set; 66(3):267-273 JE DIB et al. INTRODUCTION In craniofacial trauma, even after resolution with favorable prognosis, either with sequelae or not, cranioplasty is an almost inevitable resource used for the correction of bone defects, since in many situations it is not possible to preserve bone structure during the surgical procedures [1-5]. The skull bone can be removed by craniectomy, and in some cases, such as cranial decompression, when it is removed in a larger fragment, it may be placed underneath the abdominal fat and replaced in a second time. However in many cases, this bone may undergo a reabsorption process mainly, with the increase of the time in which it is conditioned. In other cases, the bone is removed in small fragments or presented as comminuted fractures. In these latter situations, repair of the defect can be done through the cranioplasty, which can also be used to correct numerous bone deformities, both of the skull and face [6-7]. Cranioplasty is a technique whose objective is to repair as skull deformity, which may be of primary origin (congenital) or more commonly, related to trauma resulting from various types of accidents involving drivers, motorcyclists, fire guns and accidents involving interpersonal aggressions, which can cause, besides injuries to the brain, other sequelae in the lack of protection in the skull cap and aesthetics due to bone loss [3,8]. Classified as secondary or acquired, this deformity may be corrected through the surgical technique in order to promote repair and may be performed by prosthesis implanting on the site of the damaged or removed part and is usually performed after a cerebral decompression [9-10]. Cranioplasty is a widely practiced neurosurgical procedure that not only aims to protect the underlying brain tissue from defects of the skull, but also seeks to restore the calvaria as well as a cosmetically acceptable contour [1,5,1112]. Some types of materials and techniques have been described for reconstruction of the calvaria, the most common of which are autogenous bone, titanium mesh, PMMA, porous polyeth (...truncated)