Purpose: Autologous bone removed at the time of decompressive craniectomy (DC) is always the first choice for cranioplasty. The aim of this study was to evaluate the therapeutic efficacy of cranioplasty after DC by measuring the changes in the Functional Independence Measure (FIM) score, as well as to draw a comparison with the pre-cranioplasty FIM score and to evaluate the differences in the outcomes of cases managed by 2 methods: autologous bone (group I) or titanium mesh (group II). Materials and methods: We included 47 patients (36 male and 11 female patients) who underwent unilateral cranioplasty after DC for traumatic brain injury at our institute from 2008 to 2017 in this analytical single-institution retrospective study. The primary binary predictor variable was cranioplasty reconstructive material (autologous bone or mesh). The primary outcome variable of interest was increased, decreased, or unchanged FIM score. The secondary outcome variables included evaluation of immediate complications. The Mann-Whitney U test was used to evaluate differences between scores. Results: Group I (n = 26) underwent cranioplasty using autologous bone flap, whereas group II (n = 21) underwent cranioplasty using dynamic titanium mesh. Increases in FIM scores on the motor function subscale for group I (P = .01278) and group II (P = .00112) were statistically significant. Increases in FIM scores on the cognition subscale for group I (P = .17384) and group II (P = .9492) were statistically insignificant. Evaluation of the primary outcome variable (ie, increased, decreased, or unchanged FIM scores) and secondary outcome variables (ie, immediate complications) showed a statistically insignificant difference between the 2 groups with respect to improvement (P = .51). Conclusions: This study showed that cranioplasty, irrespective of the reconstructive material, after DC in patients with traumatic brain injury results in a significant functional improvement apart from form and esthetics.

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Rohit Sharma 1, Lalit Janjani 2, Vishal Kulkarni 3, Seema Patrikar 4, Shailey Singh 5

1Classified Specialist, Oral & Maxillofacial Surgery, 11 Corps Dental Unit, C/O 56 APO, India. Electronic address: capt_rohit7@yahoo.com. 2Graded Specialist, Oral & Maxillofacial Surgery, 15 Corps Dental Unit, C/O 56 APO, India. 3Graded Specialist, Oral & Maxillofacial Surgery, 33 Corps Dental Unit, C/O 99 APO, India. 4Lecturer, Department of Preventive & Social Medicine, Armed Forces Medical College, Pune, India. 5Asst Professor, Management, Symbiosis International University, Pune, India.

J Oral Maxillofac Surg

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2018

30102878

10.1016/j.joms.2018.07.007