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Trauma Management

OMS and Other Dental Specialists

Session: Trauma Track: Hot-off-the-Press and Abstract Session

GP1d - Cranioplasty and the Potential for Reduced Complications With PSI: A 4-Year Retrospective Cohort Analysis

Thursday, September 18, 2025
4:20 PM - 4:30 PM EDT
Location: Ballroom A, Walter E. Washington Convention Center

    Presenting Author(s)

  • Amir Wolff, DMD, MD

    Attending Physician, Department of Oral & Maxillofacial Surgery
    Rambam Healthcare Campus
    Haifa, Hefa, Israel

    • Co-Author(s)

  • Adi Katz Biton, DMD

    Oral & Maxillofacial Surgery Resident
    Rambam Healthcare Campus
    Haifa, Hefa, Israel

  • Amir Bilder, DMD, MSc

    Oral & Maxillofacial Surgery Resident
    Rambam Healthcare Campus
    haifa, Hefa, Israel

  • OE

    Omri Emodi, DMD, MD

    Vice Chair, Department of Oral & Maxillofacial Surgery
    Rambam Healthcare Campus
    haifa, Hefa, Israel

  • Tal Capucha, DMD, PhD, OMFS (he/him/his)

    Staff Surgeon
    1-Division of Oral and Maxillofacial Surgery, University of Toronto, Toronto, Canada. 2-Department of Oral and Maxillofacial Surgery, Rambam Health Care, Haifa, Israel.
    haifa, Hefa, Israel

Abstract: The Neuroplastic Surgery Unit (NPS) at Rambam Healthcare Center was established in 2019. One of the first of its kind outside the USA, the main goal was to provide a dedicated adult skull and craniofacial reconstruction unit to provide cutting edge medical care to those with significant cranial injuries. We present here a retrospective review of NPS activities for all primary and referred CP cases between the years 2020-2023 (experimental group, EG) in order to learn and better improve our treatment protocols.
All CP cases were utilized with standard pericranial onlay technique for defect exposure, reconstructed with either autologous bone or implant, with a follow up average time of 17 months. We aimed to analyze the factors contributing to symptomatic complications following cranioplasties (CP) post decompressive craniectomy (DC) in a 4-year cohort of patients. Inclusion criteria were patients with large-sized skull defects following DC craniectomy (>25 cm2) that needed late reconstruction.
The outcome of the EG was compared to the control group (CG) in a similar time period 2016-2019. Prior to the establishment of the NPS center, the CG consisted of 120 CP, out of a total of 510 DC in a 4 years cohort. 80% of the cases were reconstructed with autologous bone grafts and the remaining 20% were restored with liquid PMMA and off- the-shelf titanium implants. The average surgery time from surgical incision to closure was about 4 hours and the complication rate reached approximately 27%. In the EG consisting of 230 CP case out of a total of 530 DC, 35% were reconstructed with autogenous bone and 65% of the surgeries included customized implant restorations, mainly PPE. Surgery time average was reduced to 2.5 hours and complication rates were reduced to 10.5%.
Overall results show that pericranial dissection, followed by customized implants reduces surgical time, improves CP patients outcome, and reduces the need for re-operations, when compared to subpericranial dissection techniques and usage of autologous bone flaps.

References:
1. Saxena, V., Sahoo, N. K., Rangarajan, H., & Sehgal, A. (2023). "Bridging the Breach": Cranioplasties Using Different Reconstruction Materials-An Institutional Experience. Journal of maxillofacial and oral surgery, 22(Suppl 1), 37–43. https://doi.org/10.1007/s12663-023-01908-5
2. Perozzo, F. A. G., Ku, Y. C., Kshettry, V. R., Sikder, P., Papay, F. A., Rampazzo, A., & Bassiri Gharb, B. (2024). High-Density Porous Polyethylene Implant Cranioplasty: A Systematic Review of Outcomes. The Journal of craniofacial surgery, 35(4), 1074–1079. https://doi.org/10.1097/SCS.0000000000010135
Significant cranal defect and two-piece PSI PPE restoration, including 3D design Statistics of performance since NPS founding Statistics of surgeries before NPS formation