Frontal Bone Remodeling for Gender Reassignment of the Male Forehead: A Gender-Reassignment Surgery

Gender-reassignment therapy, especially for reshaping of the forehead, can be an effective treatment to improve self-esteem. Contouring of the cranial vault, especially of the forehead, still is a rarely performed surgical procedure for gender reassignment. In addition to surgical bone remodeling, several materials have been used for remodeling and refinement of the frontal bone. But due to shortcomings of autogenous bone material and the disadvantages of polyethylene or methylmethacrylate, hydroxyapatite cement (HAC) composed of tetracalcium phosphate and dicalcium phosphate seems to be an alternative. This study aimed to analyze the clinical outcome after frontal bone remodeling with HAC for gender male-to-female reassignment. The 21 patients in the study were treated for gender reassignment of the male frontal bone using HAC. The average age of these patients was 33.4 years (range, 21–42 years). The average volume of HAC used per patient was 3.83 g. The authors’ clinical series demonstrated a satisfactory result. The surgery was easy to perform, and HAC was easy to apply and shape to suit individual needs. Overall satisfaction was very high. Therefore, HAC is a welcome alternative to the traditional use of autogenous bone graft for correction of cranial vault irregularities

Dental implants in patients with orofacial clefts: a long-term follow-up study

Aim of this study was to determine the success of implants that were inserted in patients with cleft of the lip, alveolus and palate (CLAP) and to identify prognosis-relevant factors. In a prospective evaluation, 75 implants inserted in combination with bone grafting at cleft sites of 45 patients were examined. The observation period extended 5.5 years in average (minimum 1.5, maximum 11.3 years). Implant success was evaluated clinically and radiographically and was compared to age- and gender-matched control groups. Statistic assessment included Kaplan-Meier survival analysis, Log rank tests and Cox regression analysis. In total, 10 implants were lost in 8 patients, resulting in an implant survival rate of 82.2% at the end of the observation period. Patient-related parameters of age, gender or type of cleft had no significant influence. The length of an implant was significantly related to an improved survival rate (P < 0.01). Implant survival was less in CLAP patients when compared to implant insertions in a non-cleft control group, but improved when compared to patients with bone grafting for other indications. It is concluded that implants combined with bone grafting can offer a reliable alternative in patients with CLAP

Reconstruction of orbital wall defects with calcium phosphate cement: clinical and histological findings in a sheep model

The aim of this pilot study was to investigate the potential of calcium phosphate cement in the treatment of orbital wall defect fractures in an adult sheep model, and to compare this alloplastic material to autologous calvaria split-bone grafts. Clinical, volumetric and histological examinations were carried out of both reconstruction materials. The use of cement made intraoperative corrections easier to perform, and increased the precision of reconstruction of the orbital volume. This material also proved to be osseoconductive. The two materials were used successfully in combination. Regions of most intensive remodelling were the anterior orbital floor and the adjacent orbital rim. The preliminary results of this study demonstrate the potential of calcium phosphate cement as a useful biomaterial in the reconstruction of the anterior orbital region. Further animal and clinical trials are necessary to investigate its ability as a carrier for mediators where bone healing requires influence or support