Comparison of autogenous and alloplastic cranioplasty materials following impact testing

Robert D. Wallace, Craig Salt, Petros Konofaos

Research output: Contribution to journalArticlepeer-review


Alloplastic materials are often used when significant defects exist. Benefits include no donor site morbidity, relative ease of use, limitless supply, and predictable durability. Depending on the type of alloplast, limitations include a persistent risk of extrusion and infection. Of particular interest in relation to cranioplasties is the ability of the material to provide neuroprotection. The integrity and neuroprotective properties of autologous bone flaps, polymethylmethacrylate (PMMA), and high-density porous polyethylene (PP) were evaluated following impact testing. Three groups of New Zealand white rabbits (N=4) underwent a cranioplasty with either a bone flap, PMMA, or PP. In the control group (N=4), the animals had no cranioplasty. At the end of the eighth week, an impact was delivered to the center of each cranioplasty. At necropsy each cranium and brain was evaluated grossly and histologically. There was a statistical significant difference among groups for the severity of the hemorrhage (P=0.022) and the grade of cranioplasty disruption (P=0.0045). Autologous bone was found to be the weakest of the materials tested. In this group severe injury resulted at much lower energy levels than was observed in the control, PMMA, or PP groups. Both PMMA and PP were resistant to fracture and disruption. PMMA provided the greatest neuroprotection, followed by PP. Autologous bone provided the least protection with cranioplasty disruption and severe brain injury occurring in every patient. Brain injury patterns correlated with the degree of cranioplasty disruption regardless of the cranioplasty material. Regardless of the energy of impact, lack of dislodgement generally resulted in no obvious brain injury.

Original languageEnglish (US)
Pages (from-to)1551-1557
Number of pages7
JournalJournal of Craniofacial Surgery
Issue number5
StatePublished - Jul 2015
Externally publishedYes


  • Bone flap
  • Cranioplasty
  • Impact testing
  • Polymethylmethacrylate
  • Porous polyethylene

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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