Prolonged Inflammatory Reaction to Fractured Calcium Phosphate Cement Cranioplasty Secondary to Sequestration Within the Diploe

Abstract

Calcium phosphate cement remains the choice biomaterial for cranial reconstruction and augmentation in pediatric patients after 90% completion of cranial growth, especially compared with other nonallograft alternatives. While trauma to the site of calcium phosphate augmentation is a known risk for cement fracture, subsequent micro-fragmentation and sequestration of the cement beneath the fracture site can produce a localized inflammatory reaction that requires surgical intervention to adequately address. The authors present the course of a patient undergoing a prolonged inflammatory reaction to calcium phosphate micro-fragmentation after trauma to the site of previous augmentation performed to mend bitemporal hollowing. Cement microfragmentation and migration through an associated nondisplaced fracture of the outer table required extensive debridement of the underlying diploe before the resolution was achieved. This case illustrates the need for appropriate evaluation in cases of trauma to areas with cement to mitigate the need for extensive surgical management.