[Interventions for improving the facial profile with osteoinductive bone implants]

Abstract

Osteoinductive bone allografts (autolyzed, antigen-extracted, allogeneic bone; AAA bone) were implanted in 207 cases. The patients had plastic surgery procedures to improve their profiles and were followed up for a maximum of 72 months. Twenty-two patients had an asymmetric mandible corrected with AAA bone chips. In 14 cases AAA bone implants were used for genioplasties. Forehead defects were reconstructed in 20 patients using AAA bone. Hypoplasia of the midface was corrected in 88 cases by augmentations with AAA bone chips or powder. A total of 63 patients underwent rhinoplasties in which AAA bone chips were used to shape or erect the dorsum nasi. Patient follow-up and reoperations to remove the osteosynthesis material revealed that the AAA bone implants were remodeled in the patients' own bone within several months. Less than 3% of the AAA bone implants were lost due to local infections. Except for rhinoplasties, secondary resorption of the bone allografts was extremely low. However, in cases in which strong tension resulted from scar formation or from lack of soft tissue, considerable resorption was observed, especially when AAA bone was implanted in the nose (25% of the rhinoplasties). On the other hand, this biodynamic behavior protected the implants from soft tissue perforation. In summary, AAA bone implants represent a convenient alternative to bone autografts in recipient beds with strong regenerative capacity. Since they are remodeled into the patient's bone none of the late complications found with alloplastic implants need to be expected.