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Exploring diverse biomaterials and implants in the ear, nose, and throat by understanding adverse effects and post-usage events. Literature was obtained from Scopus, PubMed, Google Scholar, and Web of Science. A comprehensive analysis was conducted on original research studies, case reports, and case series spanning from December 2010 to May 2022. Our analysis underscores that the effectiveness of cochlear implants (CIs) relies on factors such as biocompatibility, anti-inflammatory measures, and fibrosis reduction. Although silicone is employed in otologic applications, allergic reactions leading to CI extrusion are rare. In the context of partial ossicular replacement prostheses or total ossicular replacement prostheses, polyethylene grafts (Teflon) are utilized, and Nitinol-pistons are employed in stapedotomy, with adverse consequences encompassing graft extrusion and residual perforation. Chronic sphenoid sinusitis is linked to the use of Medpor porous polyethylene implants in sellar reconstruction during skull-based surgeries. Injectable collagen preparations in vocal cord paralysis lead to submucosal deposits and resultant dysphonia. Montgomery T-tubes are employed for subglottic stenosis but are associated with granulation tissue formation. Metallic tracheostomy tubes give rise to secondary foreign bodies, and double-lumen tracheostomy tubes are prone to biofilm formation. Despite numerous research studies, there remains a necessity for the refinement of implant designs to mitigate complications and enhance the overall quality of life for patients. [ABSTRACT FROM AUTHOR]

Background: Medpor microplasty is a surgical technique that involves the use of Medpor, a porous polyethylene implant, for craniofacial reconstruction and rhinoplasty surgery. This work aimed for evaluation of the usefulness of using Medpor implants for inferior turbinate reconstruction among patients with atrophic rhinitis. Methods: We performed this prospective nonrandomized clinical trial on 12 patients with Atrophic Rhinitis resistant to medical treatment in Otorhinolaryngology Department, Zagazig University managed surgically by Medpor Implantation. Endoscopic Examination, Computerized tomography (CT) scan of the PNS (both coronal and axial), Mucociliary clearance test, SNOT-25Q and ENS6Q questionnaires were done for all patients pre-operative and (3,6 and 12 months) post operative. Results: We found that 100% of patients had failure of perception before surgery while after surgery only 33.3% had failure of perception while 66.7% had success of perception with significant difference. The mean of mucociliary transient time was significantly lower in post-surgery than pre surgery(p=0.001). The median SNOT-25 pre-surgery was 25 and ranged from 18 to 40 while the median SNOT-25 post-surgery was 10 and ranged from 5 to 40 with statistically significant improvement (p=0.001). The median ENS6Q pre-surgery was 13 and ranged from 7 to 17 while the median ENS6Q post-surgery was 7 and ranged from 3 to 14 with statistically significant improvement (p=0.001). Conclusions: A novel and potentially effective method for treating atrophic rhinitis is the use of Medpor for inferior turbinate reconstruction. Endonasal microplasty with Medpor implants overcomes the limitations of synthetic materials or cartilage by effectively relieving patients' symptoms. Medpor implants have an excellent contouring size, are available in prefabricated shapes, and promote the growth of innate vasculature, which increases mechanical stability, decreases the risk of implant migration, and prevents infection. [ABSTRACT FROM AUTHOR]

Background: Auricle reconstruction is among the most challenging procedures in plastic and reconstructive surgery, and the choice of framework material is a critical decision for both surgeons and patients. This meta-analysis compared the outcomes of autologous auricle reconstruction using costal cartilage with those of alloplastic reconstruction using porous polyethylene implants. Methods: A literature review was conducted using the PubMed and Embase databases to retrieve articles published between January 2000 and June 2024. The outcomes analyzed included postoperative complications such as framework exposure, infection, skin necrosis, hematoma, and hypertrophic scars, as well as patient satisfaction. The proportions of reconstructive outcomes from each selected study were statistically analyzed using the “metaprop” function in R software. Results: Fourteen articles met our inclusion criteria. The group undergoing polyethylene implant reconstruction exhibited higher rates of framework exposure, infection, and skin necrosis, whereas the autologous reconstruction group experienced higher rates of hematoma and hypertrophic scars. Of all the complications, framework exposure was the only one to show a statistically significant difference between the two groups (p< 0.0001). In terms of patient satisfaction, those who underwent autologous cartilage reconstruction reported a higher rate of satisfaction, although this difference did not reach statistical significance in the meta-analysis (p= 0.076). Conclusion: There is no statistically significant difference in postoperative complications such as infection, hematoma, skin necrosis, and hypertrophic scars between auricle reconstructions using autologous costal cartilage and those using polyethylene implants. However, reconstructions with polyethylene implants show a significantly higher rate of framework exposure. [ABSTRACT FROM AUTHOR]

Background: Treating orbital injuries is interesting and difficult in the facial trauma. The balance in facial proportions and also the facial esthetics are required to achieve an anatomical harmony. Objective: To compare the functional results of individual reconstruction of orbital floor using either titanium mesh or Medpor in terms of various factors. Materials and Methods: There were two study groups including eight subjects with orbital floor fracture, namely A (Medpor) and B (titanium mesh). Various parameters were analyzed postoperatively at intervals of 1 week, 3 week, 6th week, and 3 months after the surgery. Statistical Analysis: Comparison of the different time points with respect to pain scores in the two study groups by Wilcoxon matched pairs test was done. P value was significant in the study Group A with P = 0.0431* and was insignificant in the study Group B with P = 0.1088. Results: All three cases of titanium mesh in orbital floor reconstruction had signs of infection, tenderness, and radiographic proof after 1 week in two subjects and 3 weeks in one patient. Pain was seen in all eight patients 1 week postoperatively. Conclusion: Although orbital reconstruction is a technique sensitive procedure both Medpore and Titanium mesh functions.

Tina M Roa,1 Peter A Netland,1 Vital P Costa,2 Steven R Sarkisian Jr,3 Lama A Al-Aswad,4 Marlene R Moster,5 Iqbal IK Ahmed6 1Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA; 2Department of Ophthalmology, University of Campinas, Campinas, Brazil; 3Oklahoma Eye Surgeons, PLLC, Oklahoma City, OK 73112, USA; 4Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY 10017, USA; 5Glaucoma Service, Wills Eye Hospital, Philadelphia, PA 19107, USA; 6Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, CanadaCorrespondence: Peter A NetlandUniversity of Virginia School of Medicine, PO Box 800715, Charlottesville, VA 22908, USATel +1 434 982-1086Email pan9c@virginia.eduPurpose: Our aim was to evaluate and compare the clinical outcomes after implantation of the silicone-plate (model FP7) and porous polyethylene-plate (model M4) Ahmed Glaucoma Valves.Patients and Methods: This was a prospective, multicenter, comparative series. A total of 52 eyes (52 patients) were treated with either the silicone or porous plate Ahmed Glaucoma Valve implant. Hypertensive phase was defined as intraocular pressure > 21 mmHg during the first 3 months postoperatively. Success was defined as 5 mmHg ≤intraocular pressure ≤ 21 mmHg (with or without additional glaucoma medications), without loss of light perception and without additional glaucoma procedures. Patients were monitored for 1 year after surgery.Results: The pre-operative intraocular pressure was 29.9 ± 6.6 mmHg and 33.8 ± 10.5 in the silicone-plate and porous-plate groups, respectively (P = 0.118). At 12 months after surgery, the mean intraocular pressure was 13.6 ± 4.7 mmHg in the silicone-plate group and 17.9 ± 10.9 mmHg in the porous-plate group (P = 0.141). The mean number of glaucoma medications at 12 months was 1.64 ± 1.40 mmHg and 1.89 ± 1.54 mmHg in the silicone- and porous-plate groups, respectively (P = 0.605). Hypertensive phase was not significantly different in the two groups (50.0% of the silicone-plate and 57.7% of the porous-plate groups, P = 0.578). At 12 months after surgery, the percent success for the silicone-plate and porous-plate groups was 88.5% and 53.8%, respectively (P = 0.005). Complications were similar in the two groups.Conclusion: The porous-plate Ahmed Glaucoma Valve showed similar average intraocular pressure reduction compared with the silicone-plate model. At 12 months after surgery, there was a significantly lower success rate in the porous-plate compared with the silicone-plate group.Keywords: Ahmed Glaucoma Valve, model FP7, model M4, glaucoma drainage implant, porous polyethylene, Medpor

The Rationale: "Frozen Eye" is a very uncommon sequel after treatment of orbital blowout fractures requiring implant placement. Patient Concerns: The implant may faultily impinge on the ocular and extra-ocular muscle(s), causing the abnormality in the movement of the eye. Diagnosis: We present a 56-year-old male whose ocular implant impinged on muscle, causing "frozen eye" and had an infected implant. Treatment Outcomes: The same was removed and surgically corrected. The manuscript describes the details and discusses the possible mechanism that led to the "Frozen Eye". [ABSTRACT FROM AUTHOR]

Auricular reconstruction for microtia is most frequently performed using autologous costal cartilage (ACC) or porous polyethylene (PPE) implants. Short-term results are generally promising, but long-term results remain unclear. Long-term outcomes were explored in this systematic review, and minimal reporting criteria were suggested for future original data studies. A systematic literature search was conducted in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from inception through October 14, 2020. Articles on auricular reconstruction in patients with microtia using ACC or PPE were included if postsurgical follow-up was at least 1 year. Outcome reporting was split into separate publications, and results on complications were reported previously. This publication focused on long-term aesthetic, patient-reported, and sensitivity outcomes. Forty-one publications reported on these outcomes. Both materials led to aesthetically pleasing results and high rates of patient satisfaction. ACC frameworks grew similarly to contralateral ears, and the anterior surface of auricles regained sensitivity. Furthermore, postoperative health-related quality of life (HRQoL) outcomes were generally good. Data synthesis was limited due to considerable variability between studies and poor study quality. No conclusions could be drawn on the superiority of either method due to the lack of comparative analyses. Future studies should minimally report (1) surgical efficacy measured using the tool provided in the UK Care Standards for the Management of Patients with Microtia and Atresia; (2) complications including framework extrusion or exposure, graft loss, framework resorption, wire exposure and scalp/auricular scar complications and (3) HRQoL before and after treatment using the EAR-Q patient-reported outcome measure (PROM). [ABSTRACT FROM AUTHOR]

Microtia is a rare disorder characterized by malformation or even complete absence of the auricle. Reconstruction is often performed using autologous costal cartilage (ACC) or porous polyethylene implants (PPE). However, the long-term outcomes of both methods are unclear. This systematic review aimed to analyze long-term complications and suggest minimal reporting criteria for future original data studies. A systematic literature search was conducted in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials from inception through October 14, 2020. Articles on auricular reconstruction in patients with microtia using ACC or PPE were included provided that the follow-up period was at least one year. This publication focused on long-term complications reported in patients with a postoperative follow-up period of at least one year. Twenty-nine publications reported on complications during long-term follow-up. Overall long-term complication rates were not reported. The incidence of individual complications during long-term follow-up was less than 10% after ACC reconstruction and less than 15% in PPE reconstruction. Framework resorption and wire exposure were reported even after an extended follow-up of more than five years after ACC reconstruction, while reports on the extended long-term results of PPE reconstruction are limited. Data synthesis was limited due to heterogeneity and poor study quality. Future studies should report on long-term complications including framework exposure or extrusion, graft loss, framework resorption, wire exposure and scalp and auricular scar complications. We recommend a surgical follow-up of at least five years. [ABSTRACT FROM AUTHOR]

Background: Treating orbital injuries is interesting and difficult in the facial trauma. The balance in facial proportions and also the facial esthetics are required to achieve an anatomical harmony. Objective: To compare the functional results of individual reconstruction of orbital floor using either titanium mesh or Medpor in terms of various factors. Materials and Methods: There were two study groups including eight subjects with orbital floor fracture, namely A (Medpor) and B (titanium mesh). Various parameters were analyzed postoperatively at intervals of 1 week, 3 week, 6th week, and 3 months after the surgery. Statistical Analysis: Comparison of the different time points with respect to pain scores in the two study groups by Wilcoxon matched pairs test was done. P value was significant in the study Group A with P = 0.0431* and was insignificant in the study Group B with P = 0.1088. Results: All three cases of titanium mesh in orbital floor reconstruction had signs of infection, tenderness, and radiographic proof after 1 week in two subjects and 3 weeks in one patient. Pain was seen in all eight patients 1 week postoperatively. Conclusion: Although orbital reconstruction is a technique sensitive procedure both Medpore and Titanium mesh functions. [ABSTRACT FROM AUTHOR]

Objective: To review a sequela of skull base reconstruction with a porous polyethylene implant. Methods: Case report. Results: A 61-year old patient with a past surgical history of transsphenoidal hypophysectomy presented with chronic post nasal drip. Endoscopy demonstrated crusting along the residual intersinus sphenoid septum. The patient was taken to the operating room to remove the residual septum, which was discovered to be a porous polyethylene implant. The implant was removed and the patient's symptoms resolved. Repeat endoscopy showed healthy mucosalization of the sphenoid sinus. Conclusions: While porous polyethylene has a relatively safe biocompatibility profile, infection, extrusion, or migration of the implant are potential complications after skull base reconstruction, and subsequent chronic sinusitis can develop. It is important for surgeons to recognize these potential complications when planning reconstruction and select appropriately.

Alloplastic malar onlays have been used by surgeons to correct or enhance the midfacial skeleton for over 40 years. Case series have shown respectable results using different alloplastic materials in various maxillofacial subsites. However, these articles include small numbers of patients with limited follow up. We present a literature review specifically concentrating on porous polyethylene (Medpor, Stryker) and polyethyl ether ketone (PEEK) malar onlays. We illustrate the technique used by a single oral and maxillofacial surgeon for placement of 119 implants in 61 patients over a 14-year period, and show the results of this work with long-term follow up. A complication rate of 2.5% in this cohort was reported, with follow up of three years, demonstrating that this technique for midfacial correction is successful in both the short and the long term. [ABSTRACT FROM AUTHOR]

The 2-stage methods of the total auricular reconstruction developed by Dr. Nagata have been widely used. In the second stage of ear reconstruction, the implanted auricle is separated from the underlying bed, and its posterior surface is covered with a skin graft or a flap. Many surgeons have used various projection blocks, such as banked cartilage or alloplastic materials, to provide the constructed auricle with adequate projection. Banked costal cartilage is most commonly used as a projection block, but it may not be possible to obtain banked cartilage in sufficient volume to ensure an acceptable projection. Previously, in this procedure, the author used a new fabricated cartilage block harvested from the fourth and fifth costal cartilages. Although this material is stable and yields acceptable results, an invasive and time-consuming procedure is necessary to obtain it. Therefore, the author considered the use of a Medpor (a high-density porous polyethylene, Stryker, USA) projection block as an alternative to the cartilage. Between January 2012 and May 2015, the author performed the second-stage operation by using a Medpor block in 51 patients. The follow-up period ranged from 1 year to 4 years. The use of a Medpor block for projection in the second stage is time-saving and less invasive. Delayed healing of the wound was noted in 2 cases, in which a deep temporal fascial flap, instead of a temporoparietal fascial flap, had been used for the coverage of the exposed framework. A hypertrophic scar was noted on the posteroinferior surface of the reconstructed ear in 1 case. However, no major complications such as infection or exposure occurred. The constructed ears showed a firm and stable projection.

Background: Porous high-density polyethylene implants (Medpor®) have been extensively used for septal extension grafts in Asian rhinoplasty. However, studies on the long-term complications associated with Medpor® have not been reported. Therefore, the purpose of this study was to evaluate the long-term complications of septal extension grafts using Medpor® and present a reconstructive strategy for destructed septal L-struts. Methods: We conducted a 12-year retrospective medical chart review of 428 patients who visited our center for septorhinoplasty. Among 428 patients, 43 patients had Medpor® for septal extension grafts previously applied at other clinics. The quadrangular cartilage was devoid or destructed in the area where Medpor® was previously applied. Therefore, all patients underwent secondary septorhinoplasty using autogenous cartilage grafts. Patient outcome was assessed to evaluate satisfaction, hardness of nasal tip, functional nasal obstruction symptom evaluation (NOSE) scores, and pain scores. Anthropometric analyses were carried out with patients' photographs. Postoperative complications were also evaluated. Results: After septal L-strut reconstruction, 87% of patients were satisfied with their aesthetic results. Hardness of nasal tip, NOSE scores, and pain scores also improved after reconstruction. Anthropometric analyses demonstrated that increased nasal length and decreased columellar–labial angle were achieved in patients with short nose deformities. No postoperative complications related to the reconstruction were recorded for any patient. Conclusions: The devastated destruction of nasal support lines was found after the use of Medpor® for septorhinoplasty. Therefore, the use of Medpor® should be reduced. Autogenous cartilage grafts are the last resort for reconstruction of destructed septal L-struts. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Three-dimensional midfacial deficiency in cleft patients is common and is frequently connected to impairment of the aesthetic facial appearance. Different approaches to augment relevant facial regions are available. Alloplastic facial implants have been established as a viable alternative to autologous tissue augmentation in various circumstances. However, in cleft patients, the application of facial implants has rarely been reported. This retrospective study aimed to evaluate the use of Medpor implants for midfacial contouring in cleft patients. Fifty-one patients with orofacial clefts were assessed with regard to defined parameters. A range of Paranasal, Malar and Nasal Dorsum Medpor implants had been used. Unilateral cleft lip and palate (UCLP) represented the most common indication, followed by bilateral cleft lip and palate (BCLP). Bilateral implant insertion was performed as a general rule with few exceptions. Insertion of implants was frequently combined with other cleft-related surgical procedures. Even after orthognathic surgery, midfacial augmentation was implemented to specifically address residual volume deficiency, particularly in the malar region. The complication rate amounted to 4.9% (6/122 implants). Based on our findings, Medpor implants are reliable and long-term stable materials to successfully augment paranasal, subnasal and malar areas as well as a solid nasal dorsum material with few complications in cleft patients. [ABSTRACT FROM AUTHOR]

Background/purpose: The Bonebridge (BB) is a newly designed transcutaneous bone conduction hearing implant. We describe, for the first time, simultaneous BB implantation and different surgical techniques of auricular reconstruction for microtia patients with aural atresia/stenosis.Methods: Ten patients with unilateral or bilateral microtia underwent BB implantation combined simultaneously with either total auricular reconstruction using bespoke hand-carved Medpor framework or second stage auricular projection using autologous costal cartilage framework. Auditory aided and unaided sound fields were evaluated using (1) a pure-tone average (PTA4), (2) a speech reception threshold (SRT), and (3) a Speech Discrimination Score (SDS) at a sound level of 65 dB SPL.Results: All patients and their families were satisfied with the aesthetic outcome of their constructed ears with no requests for further revision. No major complications were encountered. One patient developed minor partial skin graft epidermolysis that healed uneventfully, and another patient had a three month period of auditory acclimatization to the BB device that resolved. Postoperatively, the mean aided PTA4 decreased by 35.35 dB, while the SRT was 54.5 dB HL unaided and 28 dB HL with use of a BB sound processor. The SDS increased by 16.4%-65 dB SPL.Conclusion: Simultaneous BB implantation during either total auricular reconstruction or framework projection for microtia patients who have aural atresia/stenosis is feasible and safe. This approach reduces operative stages, thereby minimizing schooling/occupational disruption and time to total microtia reconstruction and auditory rehabilitation. [ABSTRACT FROM AUTHOR]

Presently described is case in which early postoperative cranial computed tomography (CT) image demonstrated hyperdense epidural mass adjacent to microporous high-density polyethylene implant (Medpor; Stryker, Kalamazoo, MI, USA) that strongly mimicked epidural hematoma. Another cranial CT image obtained 24 hours after operation indicated that epidural mass had resolved. This case is the first in the English-language literature of mock epidural hematoma related to cranial reconstruction with Medpor.

Microtia reconstruction is a complex procedure performed by the facial plastic and reconstructive surgeon and requires an expert understanding of the three-dimensional structure of the ear. This article provides an overview of the evolution of microtia reconstruction through history. Techniques pioneered by microtia surgeons Drs. Radford Tanzer, Burt Brent, Satoru Nagata, and Françoise Firmin will be described along with an additional excerpt on the utilization of porous polyethylene (Medpor; Stryker, USA). The objective for the reader is to be able to summarize approaches of each major reconstructive technique, compare the differences in techniques, and gain an understanding of the advantages and disadvantages of each approach., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Medpor is a biocompatible, high-density porous polyethylene implant that is used for multiple indications in plastic surgery. The most frequent complications associated with the Medpor implant are infection and implant exposure. The primary cause of these complications is poor fibrovascularization of the Medpor implant and poor nourishment of the overlying skin. The present experimental study aimed to determine whether vascular endothelial growth factor (VEGF) could accelerate and increase Medpor implant fibrovascularization in vivo, and thereby improve local nourishment and prevent complications. Materials and Methods: The Medpor implant was inserted under the dorsal skin area in 40 Sprague-Dawley rats. 20 rats receiving local VEGF injections comprised the study group. The control group received saline injections. Fibrovascularization of the Medpor implants was compared. Results: In the rats injected with VEGF, the Medpor implant fibrovascularized faster, and there were more newly formed blood vessels, as compared with those in the control group. Conclusion: These findings have led to our use of VEGF-like agents that the accelerate angiogenesis in the Medpor implant as a means to reduce the incidence of such complications as infection and implant exposure. [Arch Clin Exp Surg 2015; 4(4.000): 196-201]

Background Temporal bone tegmen defects may be associated with cerebrospinal fluid (CSF) otorrhea. A variety of techniques have been used for repair. We report our experience with skull base reconstruction for tegmen defects using either autologous or alloplastic grafts. Methods A retrospective chart review was performed on patients with tegmen defects treated from 2007 to 2017 at the University Hospital in Columbia, Missouri, USA. Primary outcome measures were analyzed. Results Twenty-five patients were treated with a middle cranial fossa approach (median age 53, 88% females, median body mass index 34, median follow-up 9 months). Presenting symptoms included CSF leak (92%), hearing loss (44%), imbalance (12%), meningitis (12%), headache (4%), and tinnitus (4%). Most tegmen defects occurred spontaneously (84%) but cholesteatomas (4%), and trauma (12%) also were identified. Pre- and postoperative audiograms were available for 13 patients (52%); 7 (54%) showed objective improvement. Fourteen patients were repaired with autologous bone graft (56%), 7 with alloplastic grafts (28%), and 4 with temporalis fascia only (16%). All patients had resolution of CSF leak. Two patients (8%) suffered wound infections and 3 (12%) had facial and/or petrosal nerve complications. Use of alloplastic graft significantly shortened operative time (allopathic mean 180 minutes vs. autologous mean 208 minutes; P = 0.03). Conclusions CSF otorrhea due to tegmen defects can be repaired via a middle fossa craniotomy using either an autologous or alloplastic graft with equivalent outcomes and efficacy, although alloplastic graft helps reduce operating time. Highlights • A middle fossa craniotomy alone can be used to repair most tegmen defects of the temporal bone. • An allograft, such as MEDPOR, can reduce operative time in reconstructing tegmen defects. • Obesity appears to be a common association with tegmen defects of the temporal bone. [ABSTRACT FROM AUTHOR]

Summary Background Both autologous costal cartilage (ACC) and alloplastic materials are widely used in rhinoplasty. However, there is controversy regarding which material can offer the ideal outcome and fewer complications. Objective The authors review current literature to evaluate complication and satisfaction rates with different materials used in rhinoplasty. Methods A comprehensive literature search of articles was conducted in Embase and PubMed published through April 14, 2017. We included only articles that used ACC, silicone, Medpor, Gore-Tex, or a combination of autologous and alloplastic materials in rhinoplasty. The primary outcomes analyzed were complications and postoperative satisfaction. After data extraction, meta-analysis using the random effect model was performed to summarize outcome parameters among different implant types. Results Fifty-three articles met inclusion criteria and were included in the meta-analysis. The overall complication rate of ACC was 14%, which was higher than that of other implants. However, ACC was more commonly used in revision rhinoplasty. Medpor was associated with low overall complication rates (6%) and good aesthetic and functional outcomes. Conclusions Our analysis of available evidence suggests that ACC is preferred in revision rhinoplasty, which may explain its association with higher complication rates. In primary rhinoplasty, Medpor offered versatility in addition to low complication rates and good aesthetic and function outcomes. But its potential dramatic damage to the nasal tissue made secondary surgery extremely difficult. Our findings were limited by lack of high-quality evidence. Future studies with rigorous study design for head-to-head comparisons and longer follow-up are needed to establish clear guidelines for choosing the appropriate rhinoplasty graft material. [ABSTRACT FROM AUTHOR]

Background: The mandibular contour plays a significant role in the beautiful and youthful look but the reconstruction remains a challenging problem. The objective of this study was to evaluate the use of individualized high-density porous polyethylene (Medpor) implants for comprehensive reconstruction of mandibular contour with the aid of computer-aided design/computer-aided manufacturing (CAD/CAM). Methods: From 2010 to 2014, 12 patients with mandibular contour deformities were enrolled in our retrospective study. Mandible models and individualized surgical templates were fabricated by three-dimensional (3D) printing and Medpor implants were made according to the surgical templates. The Medpor implants were used for both unilateral and bilateral mandibular contour deformities. In four cases, simultaneous mandibular orthognathic surgery was performed with unilateral mandibular contour reconstruction. Results: Eleven patients had a reposeful postoperative recovery with no complication. Delayed infection was shown in one patient and the Medpor implant was removed. All the 11 patients had the mandibular contour reconstructed satisfactorily. Conclusion: The technique and cases presented demonstrate the utility of Medpor implants with CAD/CAM in comprehensive mandibular contour reconstruction. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Total ear reconstruction has been approached by several techniques involving autologous graft, prosthetic implant, and alloplastic implant options. Recent studies have shown the superiority of porous polyethylene (Medpor, Porex Surgical) reconstruction over autologous reconstruction based on improved aesthetic results, earlier age of intervention, shorter surgery times, fewer number of required procedures, and a simpler postoperative recovery process. A durable and permanent option for total ear reconstruction, like Medpor, can help alleviate the cosmetic concerns that patients with auricular deformities may be burdened with on a daily basis. In this article, the authors discuss the advantages of Medpor-based ear reconstruction and discuss recent advances in the surgical techniques involved, such as harvesting a temporoparietal fascia flap and full-thickness skin graft to adequately cover the Medpor framework and decrease extrusion rates. [ABSTRACT FROM AUTHOR]

BackgroundCryptotia is a congenital ear deformity in which the upper pole appears buried beneath the mastoid skin. Cryptotia is a common auricular malformation among Asians. The aim of this paper is to examine the surgical techniques for and complications of 34 cryptotic patients.MethodsSurgery was performed for 34 cryptotic deformities (January 2005 to January 2012). Twenty-two patients (64.7%) were classified as having type I cryptotia, and 12 patients (37.5%) type II cryptotia. Among the type I cryptotia patients, 8 patients had mild deformity and 14 severe deformity. Among the type II cryptotia patients, 10 patients had mild deformity and 2 severe deformity.ResultsThe mild deformities were corrected via Z-plasty, V-Y plasty, full-thickness skin graft, and transposition flap, while the severe deformities were corrected via cartilage graft or Medporfor the spread of cartilage adhesion of antihelix. There were two cases of reinvagination in the autologous cartilage graft group. Implant exposure occurred with Medpor (two cases). There were two cases of hypertrophic scar on the previous surgical wound with Medpor. There were no complications in the 18 patients who had mild deformities.ConclusionsThe type I cryptotia patients had more severe deformities than the type II cryptotia patients. As most of the type II cryptotia patients had only mild deformities, their deformities were corrected without using autologous conchal cartilage graft or Medpor, except for two patients. Through more case analyses, researchers should make an effort to identify methods for recurrence and prevention of complication.

ObjectivesEvaluation of a new material, high-density porous polyethylene (HDPP), which is covered with fascia lata, for experimental nasal septal perforation closure.MethodsTwenty New Zealand albino rabbits were included and divided into study and control groups. A lateral incision was made from the lateral aspect of the left nares to the incisura nasomaxillaris. After exposure of the cavum nasi, the nasal mucoperichondrium was elevated bilaterally. A full-thickness 0.5×0.5-cm perforation was created over the septum nasi with a No. 11 surgical blade. A fascia lata graft was used for the study group. The HDPP was covered with fascia lata and placed under the elevated mucosa. HDPP without a fascial covering was used in the control group. Four months after the procedure, magnetic resonance imaging was performed to evaluate resorption of the material. The animals were sacrificed, and the nasal septum was completely removed. Macroscopic and histopathological examinations were performed on the nasal septum.ResultsAll rabbits had survived after the 4-month period. Macroscopically, nine of 10 (90%) perforations were closed in the fascia lata-covered HDPP group. Histopathological examination of these nine rabbits revealed that the continuity of cartilage was disturbed in the perforation areas. Granulation tissue was inverted in areas in which the cartilage continuity was disturbed. The HDPP had remained intact at the edge of the perforation. In the HDPP group, six of 10 implants were still perforated (60%) and four (40%) were closed. The fascia lata-covered HDPP implant had a significantly higher perforation closure rate than that of the HDPP implant alone (P

AIM: To observe the efficacy of Medpor porous polyethylene implants in treatment of enophthalmos combined with orbital fracture. METHODS: Seventeen cases(17 eyes)with enophthalmos caused by orbital fracture underwent surgical treatment with Medpor porous polyethylene implants. All accepted a 6-mo follow-up and the data of enophthalmos, eyeball movement and diplopia were collected. RESULTS: The average difference of exophthalmos between damaged eyes and undamaged eyes was(3.4±1.5)mm preoperatively, two cases had residual 1mm enophthalmos 6mo after surgery, while other 15 cases were completely corrected. Seventeen cases suffered from eyeball movement restriction and diplopia preoperatively, 16 cases had normal eyeball movement without diplopia 6mo after surgery, 1 case with limitation of abduction and horizontal diplopia. There was no extrusion, rejection, infection or other complications occurred during follow-up. CONCLUSION: Medpor porous polyethylene implants can effectively improve the orbit volume to repair enophthalmos caused by orbital fracture.

Allogenic implants are an effective alternative to autologous grafts in the reconstruction of facial defects. These implants are used to reconstruct a variety of bony and soft-tissue defects, including the frontal and temporal regions; internal orbit; infraorbital rim; malar, paranasal, and nasal regions; mandible; and chin. In comparison to their autologous counterparts, alloplastic materials are more readily available, lack donor-site morbidity, decrease surgical time and cost, and still have relatively good postoperative tissue tolerance. However, these implants are not without their own spectrum of complications. Common solid implant materials include silicone, GoreTex (expanded polytetrafluorethylene; W. L. Gore & Associates Inc., Flagstaff, AZ), MedPor (high-density porous polyethylene; Porex Industries, Fairburn, GA), and Mersilene mesh (nonresorbable polyester fiber; Ethicon, Somerville, NJ). Each of these materials poses certain complication risks based on their surface contour (smooth vs. porous), pliability, and reactivity with surrounding tissue. In addition, certain implant locations within the head and neck are at risk for different postoperative complications. Although there are no evidence-based guidelines for implant reconstruction to help avoid common complications, there are several principles and techniques that are commonly employed by surgeons to help reduce complication rates. These include careful patient selection, proper choice of operative procedure, infection control practices (including pre/intraoperative systemic antibiotics, meticulous aseptic technique, impregnation/soaking of implant in antibiotic, irrigation of implant pocket with antibiotic, careful closure of tissue layers, and postoperative oral antibiotics), preoperative implant shaping, choice of surgical approach, and intraoperative surgical techniques. Larger, controlled trials are needed to confirm the efficacy of the aforementioned techniques in the reduction of postoperative complications. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the effect of porous polyethylene in paranasal augmentation on the overlying soft tissue. Thirty-three patients underwent paranasal augmentation using 3-mm-thick porous polyethylene and mandibular setback, and 35 patients underwent mandibular setback only. Lateral cephalograms were taken before and 6 months after the surgery to compare the soft-tissue changes in the paranasal area. Complications and patient satisfaction following the surgery were also analyzed. The average soft-tissue change in the paranasal area after the augmentation was 2.42 ± 0.33 mm, while there was no definite soft-tissue change in the paranasal area after mandibular setback alone. The ratio of soft-tissue changes to paranasal implant thickness was 80.7%. All patients in the augmentation group were satisfied with their surgical outcomes, which led to convex lateral profile with increase in midface volume. There were no complications such as postoperative infection or foreign body reaction requiring removal of implants. Paranasal augmentation using porous polyethylene is a predictable method providing minimal morbidity in patients with paranasal deficiency. [ABSTRACT FROM AUTHOR]

BACKGROUND: Key factors for successful porous polyethylene (PPE) implantation are rapid vascularization and low inflammatory response. Dermal fibroblasts produce a variety of pro-angiogenic and immunmodulatory factors. OBJECTIVE: The aim of this tissue engineering study was to investigate whether coating PPE implants with dermal fibroblasts in vitro is sustainable in vivo and whether the kinetics of blood vessel ingrowth and immunological responses are hereby affected. METHODS: PPE implants were cultured with syngeneic GFP-transfected dermal fibroblasts. Cells on the biomaterial were quantified before implantation into dorsal skinfold chamber preparations of C57Bl/6 mice. Uncoated implants served as controls. Angiogenic activity and leukocyte-endothelial cell interactions were repeatedly analyzed. After 10 days, mechanical integration was measured and surviving fluorescently labeled fibroblasts were quantified. Expression of inflammatory cytokines was assessed by quantitative real time-reverse transcription PCR. RESULTS: PPE implants were successfully coated with dermal fibroblasts in vitro and 69% of the cells were still detectable at the end of observation. Angiogenic parameters increased during the observation period in both groups. IL-2, IL17A and IL-10 tended to be increased in coated implants, but did not affect leukocyte-endothelial cell interactions. CONCLUSIONS: Dermal fibroblast-coating of porous polyethylene implants is feasible and sustainable in vivo. Alone it does not improve biocompatibility but may be beneficial in combination with specific growth factor supplements. [ABSTRACT FROM AUTHOR]

Alloplastic facial implants have a wide range of uses to achieve the appropriate facial contour. A variety of materials such as metals, polymers, ceramics and synthetic injectable fillers are available to the reconstructive and aesthetic surgeon. Besides choosing the right surgical technique and the adequate material, the surgeon must be prepared to treat complications. Infection is an uncommon but serious complication that can cause displeasing consequences for the patient. There are few references in literature regarding treatment and management of facial implant-related infections. This study aims to discuss the role of biofilm in predisposing alloplastic materials to infection, to provide a review of literature, to describe our own institutional experience, and to define a patient care pathway for facial implant-associated infection. [ABSTRACT FROM AUTHOR]

Microtia reconstruction using porous polyethylene implants has become an established alternative to autologous costal cartilage techniques. Few surgeons are trained in porous implant ear reconstruction (PIER), leading to a relative lack of understanding of the nuances of this type of surgery. The risks of exposure, infection, and fracture of the implant have further discouraged surgeons from performing PIERs. Meticulous technique and proper management of complications are critical to the success of surgeries involving porous implants (Medpor, Su-Por). There are a limited number of articles in the literature that report the management of complications of porous implant auricular reconstruction. The purpose of this work is to present a comprehensive review of the management of complications with PIER based on over 10 years of experience with this surgical technique. [ABSTRACT FROM AUTHOR]

Purpose Scalp management is challenging in all types of cranioplasties, particularly following decompression or in case of resorption of a repositioned bone flap. In these cases, reduction of brain volume is constantly associated with tightening of the skin cover. Material and methods A retrospective analysis of 36 cranioplasties was performed. All patients showed cranial decompression or a large craniectomy. In all cases, cranioplasty was preceded by a preliminary scalp expansion. Results Two patients had expander exposure. One of them underwent re-intervention, to reposition the implant. Complications of the cranioplasty phase were one case of extradural hematoma, five cases of swelling due to liquorrea, four cases of temporary forehead edema, and one case of temporal bulging due to the implant. Cranial decompression and other craniectomy procedures often produce a tightening of the scalp, which makes the cranioplasty problematic. The preliminary systematic scalp expansion performed in all patients resulted in a convenient skin excess that allowed a tension-less closure, preventing the scalp suture from falling right on the edge of the cranioplasty implant. Conclusion A systematic preliminary scalp expansion allows one to minimize cranioplasty complications in patients with craniectomies, to anticipate possible necrotic scalp complications in the expansion phase rather than in the cranioplasty phase, and thereby avoid implant loss. [ABSTRACT FROM AUTHOR]

Objective The Medpor porous polyethylene implant provides benefits to perform sellar floor reconstruction when indicated. This material has been used for cranioplasty and reconstruction of skull base defects and facial fractures. We present the most extensive use of this implant for sellar floor reconstruction and document the safety and benefits provided by this unique implant. Methods The medical charts for 200 consecutive patients undergoing endonasal transsphenoidal surgery from April 2008 through December 2011 were reviewed. Material used for sellar floor reconstruction, pathologic diagnosis, immediate inpatient complications, and long-term complications were documented and analyzed. Outpatient follow-up was documented for a minimum of 1-year duration, extending in some patients up to 5 years. Results Of the 200 consecutive patients, 136 received sellar floor cranioplasty using the Medpor implant. Postoperative complications included 6 complaints of sinus irritation or drainage, 1 postoperative cerebrospinal fluid leak requiring operative re-exploration, 1 event of tension pneumocephalus requiring operative decompression, 1 case of aseptic meningitis, 1 subdural hematoma, and 1 case of epistaxis. The incidence of these complications did not differ from the autologous nasal bone group in a statistically significant manner. Conclusions Sellar floor reconstruction remains an important part of transsphenoidal surgery to prevent postoperative complications. Various autologous and synthetic options are available to reconstruct the sellar floor, and the Medpor implant is a safe and effective option. The complication rate after surgery is equivalent to or less frequent than other methods of reconstruction and the implant is readily incorporated into host tissue after implantation, minimizing infectious risk. [ABSTRACT FROM AUTHOR]

Alloplastic implants have been used to repair orbital wall fractures in most cases. Orbital hemorrhage is a rare complication of these implants and has been reported rarely in Korea. The purpose of this article is to report a late complication case focusing on their etiology and management. A 20-year-old male patient underwent open reduction with Medpor (porous polyethylene) insertion for bilateral orbital floor fractures. The initial symptom occurred with proptosis in the right side as well as vertical dystopia, which had started 4 days earlier, 8 months after surgery. Any trauma history after the surgery was not present. We performed an exploration and removal of hematoma with Medpor titanium meshed alloplastic implant. A case of delayed orbital hematoma following alloplastic implant insertion was identified. It occurred within the pseudocapsule of the implant. One week after surgery, overall symptoms improved successfully, and no complications were reported during the 11-month follow-up period. Although rare, orbital hemorrhage is a potential complication of alloplastic orbital floor implants, which may present many years after surgery. As in the case presented, delayed hematoma should be included in the differential diagnosis of late proptosis or orbital dystopia. [ABSTRACT FROM AUTHOR]

Summary Objectives Microtia ranges from a smaller ear to the absence of the external ear and has been associated with psychosocial distress. Traditional ear reconstruction takes place beginning at age six. Use of an alloplastic implant allows for earlier surgery starting at age three, which may reduce potential negative psychological effects. However, few studies have examined psychosocial outcomes of ear reconstruction with groups that include young children. Methods Children ( N = 23) with microtia and their parents completed two microtia-related scales, negative emotions and microtia social awareness, and the Behavioral Assessment System for Children – Second Edition (BASC-2) subscales of anxiety, depression, and social skills before surgery and one year after surgery. Participants (74% male) were three to nine years old with a mean age of 6.13 ± 2.10 years and were grouped by age at surgery, three to six years ( n = 11) or seven to ten years ( n = 12). The sample identified as Latino (96%) or “other” (4%). Results Pre and postoperative scores by age group were compared using two-way repeated measures analyses of variance. Children and parents reported significantly less negative emotion and microtia social awareness following surgery, with an interaction for parental report of older children showing higher negative emotion preoperatively. Older children also had higher scores of depression and anxiety before surgery and both groups reported significant decreases following surgery, along with improved social skills. Older children showed significantly greater gains in social skills. Conclusion All participants and their parents reported improved psychological functioning postoperatively. However, older children may be at greater risk of psychological concerns given the longer time they have to cope with the impact of microtia on self-image and exposure to social stressors. Undergoing reconstructive surgery earlier may be a protective factor for children with microtia. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis Patients with empty nose syndrome experience considerable discomfort in their daily lives and treatment is difficult for their physicians. The purpose of this study was to evaluate the outcome of an empty nose syndrome treatment via reconstruction of the inferior turbinate with porous polyethylene (Medpor). Design and Method A prospective self-controlled study was conducted, and 19 patients suffering from empty nose syndrome underwent a surgical therapy through submucosal implantation of Medpor in order to reconstruct their inferior turbinate. The outcome was assessed by comparison of the preoperative and follow-up symptoms, nasal endoscopy findings, CT scans, mucociliary clearance, acoustic rhinometry, and the Sino-Nasal Outcome Test-20 scores. Results In a follow-up period of 3 to 18 months, all patients reported subjective symptom improvements and a statistically significant improvement of the Sino-Nasal Outcome Test scores was achieved ( P < 0.05). Mucociliary clearance assessments showed improvements at 3, 6, and 12 months postoperatively, but without statistical significance. Acoustic rhinometry assessments showed postoperative improvements of nasal resistance, nasal volume, and minimum cross-sectional area with a significant overall average score ( P < 0.05). Conclusion The reconstruction of inferior turbinate with Medpor is a new promising approach to treat patients with empty nose syndrome. Level of Evidence 4. [ABSTRACT FROM AUTHOR]

Background: Commonly used chin implants are made of silicone, expanded polytetrafluoroethylene (e-PTFE), or high-density porous polyethylene (MEDPOR). Although MEDPOR is an effective implant for chin augmentation, modification of the external aspect of the implant is recommended, particularly for Asian patients, to create an appropriate shape for the new chin. It is often difficult to contour the inner aspect of the implant to conform to the patient's mandible. Without modification, a gap may exist between the implant and mandible. To address this problem, a modified augmentation technique was developed. Objectives: The authors describe their modified technique for MEDPOR chin augmentation, which includes removal of the genial tubercles and, if necessary, the mental protuberance. Methods: Ninety-five patients underwent the modified MEDPOR technique of chin augmentation. Before placement of the contoured implant, a drill was used to remove the patient's genial tubercles. If the mental protuberance was deemed too prominent, it was removed as well. The implant was inserted and fixed to the mandible with 2 titanium screws. Results: Results were satisfactory in 90 cases. Chin shape was too "strong" in 4 patients, and another patient had poor transition between the implant and mandible. Complications were minimal. The most common complication in this modified technique was lower lip numbness, which was transient in all cases. Conclusions: The MEDPOR chin implant can be effectively contoured to the mandible by removing the genial tubercle and/or mental protuberance. This technique is less invasive than chin osteotomy. Successful results can be achieved with minimal risks. [ABSTRACT FROM AUTHOR]

Medpor is a biocompatible, porous, high-density polyethylene implant material used as a skeleton substitute. During the last two decades, it has been successfully applied for aesthetic contour enhancement and at reconstruction of the facial skeleton. Reports on the long-term host tissue tolerance of Medpor are sparse. Use of foreign materials in nasal reconstruction has always been and still is controversial. The main contra-argument maintains that it is not known how alloplastic materials are tolerated by the human body in the long term. This study brings such data concerning the biocompatibility of Medpor. The author has 16 years of experience working with Medpor implants, including its use in rhinoplasty, chin augmentation, and malar augmentation. In this prospective study from 1996 to 2012, Medpor was used in 118 implants for 102 patients. The most frequent indications were nose deformity ( n = 61), chin hypoplasia ( n = 33), and malar hypoplasia ( n = 6). The follow-up periods ranged from 6 months to 15 years (median, 7 years). Of 42 difficult nasal reconstructions performed with the assistance of Medpor, 28 were catastrophe noses that had undergone two to four previous surgeries elsewhere. A total of 19 patients had saddle nose deformity. Of the nasal reconstructions, 85 % had a smooth clinical course, with results remaining stable during the observation time. Five biopsies confirmed soft tissue ingrowths and collagen deposition, with subsequent vascularization. All complications could be mastered. Two dorsal struts and two chin implants required trimming. Infection occurred in three rhinoplasty cases, and partial extrusion occurred in two cases. All augmented chins and malar prominences were firm and bony-like at palpation. Of the 106 Medpor implants in the followed-up patients, some were trimmed or removed, but 97 implants (91 %) remained unchanged. Implantation of porous polyethylene in the facial region is a safe procedure. Currently, Medpor seems to be the best alloplastic material available as a facial bone substitute. It is long-lasting, with a low frequency of complications, morbidity similar to procedures involving autologous grafts, and high overall patient satisfaction. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Background: We used the irradiated homograft rib cartilage as an augmentation tip support and Medpore alloplast for reconstruction of the dorsum in patients with saddle nose deformities. Thereafter, the safety and efficiency of this method was evaluated to determine if this can be a safe and efficient technique for patients with saddle nose deformities. Methods: A total of 32 patients who suffered from saddle nose deformities due to past trauma or aggressive rhinoplasty underwent reconstruction using the Medpor prosthesis for dorsum reconstruction and irradiated rib cartilage as acolumellar strut during the same technique. After at least one year follow up, patients' satisfaction and their aesthetic indexes were evaluated and compared with preoperative results. Results: More than 84% of patients were satisfied from the results of the surgery and only one patient had a complication of the infection which resulted in removal of the prosthesis. There were statistically significant differences between most of the pre- and postoperative aesthetic indexes. Conclusion: Despite the superiority of autogenous material in nose reconstruction, lack of such materials in revision rhinoplasty cases present challenges to surgeons. This study proposes the safety and efficiency of the Medpor alloplast for reconstruction of the dorsum and irradiated rib cartilage for the tip, at least for a short period of time. [ABSTRACT FROM AUTHOR]