V. Suresh1, R. Anolik1, D. Powers1 1Duke University Medical Center,Durham, NC, USA
Introduction: Poly(aryl-ether-ether-ketone) (PEEK) implants have become increasingly popular for use in trauma, orthopedic, and reconstructive procedures. PEEK’s utility is derived from chemical and mechanical properties such as temperature stability, water-resistance, and an elastic modulus that is close to that of human cortical bone. Additionally, both in vivo and in vitro studies have shown that PEEK exhibits good biocompatibility and generates minimal inflammatory responses after implantation. As the utilization of PEEK becomes more ubiquitous in the field of craniomaxillofacial trauma and reconstructive surgery, it is imperative to understand the potential consequence of employing this biomaterial in anatomic sites that may pose a risk of infection. Specifically, the use of PEEK in reconstruction of the walls of paranasal sinus cavities is not well documented in the literature. The primary aim of this study is to examine the rate of post-operative complications, namely surgical site infection and implant loss, in patients who have undergone craniomaxillofacial procedures with sinus cavity wall reconstruction using PEEK implants.
Methods: This study is a single center case series. All patients that underwent craniomaxillofacial reconstruction with a custom made PEEK implant in intimate contact with a functional paranasal sinus from June 1, 2013 to May 31, 2017 were included in this study. Baseline characteristics were collected via retrospective chart review. Mechanism of injury, operation time (measured from time of incision to closure), anatomic site of implant, size of implant, perioperative/post-operative antibiotic regimens, follow-up time, and post-operative complications (surgical site infection, readmission within 30 days of procedure, bleeding complications, loss of implant, and/or death) were recorded.
Results: A total of 8 patients were included in this case series. The average age of these patients were 45.75 ± 19.36 years old. Mechanisms of injury ranged from self-inflicted gunshot wounds to facial trauma following an explosion. Average follow-up duration was 300 ± 263 days. The mean operative time for PEEK implantation was 214.13 ± 66.03 minutes and implants ranged in size from approximately 5 sq cm to nearly 100 sq cm. One patient underwent explantation of his PEEK implant secondary to breakdown of the overlying skin due to coagulase-negative S. epidermis infection. No patients were diagnosed with acute or chronic sinusitis after implantation of their custom-designed PEEK implants.
Conclusions: A review of the literature indicates that this is the largest case series reported to date documenting the use of PEEK implants in reconstruction of the walls of the paranasal sinuses. The authors conclude that PEEK implants may be safely utilized in craniomaxillofacial procedures that involve paranasal sinus cavities without increasing the risk of infection and need for explant.