前額部におけるチタンミニプレート埋入法―不快な膨隆の回避策

Technique for Embedding a Titanium Miniplate in the Forehead that Avoids Objectionable Bulges

Ⅰ．はじめに

　今日の開頭術ではチタンミニプレート（以下，プレート）による骨弁固定が簡便性と確実性のため普及している．しかし一方で，皮膚が薄い部位では外観上プレートの厚みが膨隆する，不快な膨隆としてプレートを触知する，プレートの膨隆が皮膚を刺激するなどのデザイン上の問題もあり，これらは特に前額部において深刻となる^1,4)．

　前額部におけるプレートの膨隆を回避するための方法を提示する．

　Objective: As the fixation of cranial bone flaps with titanium miniplates may produce esthetically objectionable bulges especially on the forehead covered with thin scalp, we developed a technique that solves this problem.

　Patients and Methods: The study material consisted of 19 consecutive sides treated by frontotemporal cranioplasty using free bone flaps and miniplate-fixation. A pit matching the width and depth of the miniplate was drilled on the outer table, the miniplate was embedded in the pit in the forehead and fixed with screws.

　Results: Fixation of the bone flap was successful on 18 sides. In one instance the outer table lost the strength to sustain the screws due to excessively deep drilling. No esthetically objectionable bulges were noted even in patients with a thin scalp cover.

　Conclusions: This simple technique avoids the development of bulges and provides satisfactory cosmetic results. The key to this technique is preservation of the outer table at the bottom of the pit (more than 1 mm in thickness) to assure the stability of the fixation screws.