Author Topic: who here had HA paste to the orbital rims  (Read 4352 times)

molestrip

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Re: who here had HA paste to the orbital rims
« Reply #15 on: May 12, 2016, 02:42:52 PM »
Demineralized-bone matrix (DBX) would be my material of choice. I haven't looked too closely but I believe it's cadaver bone that's had soft tissue removed to remove risk of rejection and increase osteoconductive potential. Unlike HA, which is bone-like, DBX IS bone. It comes in different formulations, solid, putty, and paste. I posted a while ago about Dr Genecov in Dallas using it for midface augmentation according to the website. The case study was from 2006 where the putty was used to fill voids to avoid palpable defects in a double jaw surgery patient. The surgeons in Houston have been using it for CCW grafts for over a decade now without issue I'm told. I wonder if a resorbable version might be created that could be injectable to add volume non-surgically some day.

My impression is that surgeons tend to use materials and techniques that they're comfortable with. They have a limited budget for trying new things out because their reputation can't afford too many failures. I'd guess HA problems were due to foreign body reactions rather than infection, though it's probably hard to differentiate them in practice. And I was told the same, once added it can't be removed.

One place where grafting doesn't work, btw, is the notch after BSSO. Apparently even vascularized grafts failed when tried on rabbits. The best techniques to solve this problem are the inferior border osteotomy, picking young patients, and limiting advancement. And I think there's a reason the inferior border osteotomy hasn't been widely adopted.
« Last Edit: May 12, 2016, 02:58:14 PM by molestrip »

Schrödingers Jaw

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Re: who here had HA paste to the orbital rims
« Reply #16 on: May 13, 2016, 03:24:40 PM »
Demineralized-bone matrix (DBX) would be my material of choice. I haven't looked too closely but I believe it's cadaver bone that's had soft tissue removed to remove risk of rejection and increase osteoconductive potential. Unlike HA, which is bone-like, DBX IS bone. It comes in different formulations, solid, putty, and paste. I posted a while ago about Dr Genecov in Dallas using it for midface augmentation according to the website. The case study was from 2006 where the putty was used to fill voids to avoid palpable defects in a double jaw surgery patient. The surgeons in Houston have been using it for CCW grafts for over a decade now without issue I'm told. I wonder if a resorbable version might be created that could be injectable to add volume non-surgically some day.

My impression is that surgeons tend to use materials and techniques that they're comfortable with. They have a limited budget for trying new things out because their reputation can't afford too many failures. I'd guess HA problems were due to foreign body reactions rather than infection, though it's probably hard to differentiate them in practice. And I was told the same, once added it can't be removed.

One place where grafting doesn't work, btw, is the notch after BSSO. Apparently even vascularized grafts failed when tried on rabbits. The best techniques to solve this problem are the inferior border osteotomy, picking young patients, and limiting advancement. And I think there's a reason the inferior border osteotomy hasn't been widely adopted.

Sounds like it's a pretty niche material, how many surgeons really use it?

molestrip

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Re: who here had HA paste to the orbital rims
« Reply #17 on: May 16, 2016, 01:56:39 PM »
We could email them and ask but I don't see why it'd be any more niche than any of the other bone replacement products out there. It's just another offering available to surgeons. I know the surgeons in Houston like it and have gotten great results with it. Thinking about it, jaw surgery, while common now, is not some highly specialized highly refined product yet. Lots of products with limited studies and lack of consensus among surgeons about the best technique. Even the high volume guys simply don't do enough procedures to get to that point. Most don't publish so a lot of data never gets shared.