Craniofacial contour defect reconstruction with a dacron/urethane composite: an alloplastic tray for bone induction fabrication and application.

An alloplastic tray made of poly(ethylene terephthalate) cloth mesh and poly(ether urethane) used in conjunction with cancellous bone-chip grafts is the basis for this new method of reconstructing facial osseous contour defects. The tray can be prefabricated in quantity and at low cost for standard defects, such as discontinuity defects of the mandible or for chin augmentation. It can be custom-fabricated for specific defects in individual patients as, for example, gunshot wounds to the forehead. The materials were chosen because of their known histocompatibility, the ease of fabrication, and because the materials can be molded to form esthetic contours. The can be easily modified at the time of surgery. Sterilization is by autoclaving. Initial studied were undertaken in mongrel dogs where mandibular discontinuity defects in the range of 2-4 cm were reconstructed. In man, the technique has been used to reconstruct discontinuity defects of the mandible ranging in size from 1.5-12 cm in 16 patients. Atrophic mandibular alveolar ridges have been augmented using this technique in 7 patients, thus providing an adequate alveolar ridge for dentures. Two patients with defects of the skull secondary to gunshot wounds have had frontal bone restoration using this method. Reconstructions of the ear, the chin, and the orbital floor are currently being evaluated. This technique overcomes many problems of esthetic contour reconstruction and combines the use of autogenous cancellous particulate bone and a tissue-compatible synthetic composite material.