Basic Biomechanics for Craniofacial Surgeons: The Responses of Alloplastic Materials and Living Tissues to Mechanical Forces

Many terms such as twist, compress, bend, and stretch, describe how materials behave when subjected to mechanical stresses. Subjective adjectives to describe the property of materials such as hard or brittle are imprecise and impedes proper understanding of important principles needed in planning and performing surgical treatments. The viability of tissue and time dependent variables effect healing and compound the issue. Some parameters are time dependent (strain rate), while others are nearly independent of time (Young’s modulus). The craniofacial skeleton and enveloping soft tissues are viscoelastic composite materials which undergo time-dependent changes upon loading. The ability to remodel and respond to environmental changes makes them “smart,” reenforcing where needed and removing where not required based on a set of predetermined upper and lower thresholds. This mini review has 7 sections on engineering principles that underpin craniofacial surgery: (1) The general concept of mechanics: load, force, stress, strain, compression, tension, shear, stress-strain curves and values derived from them such as Young’s modulus, fatigue damage, and load- shearing. (2) Material properties of bone and suture and structural engineering of the craniofacial skeleton in normal and pathological conditions. (3) Fixation using wires, screws, and plates: anatomy and function of screws and plates, locking plates, lag screws, internal and external fixators. (4) Biomechanics of distraction osteogenesis and the effects of radiation. (5) Finite element analysis and other computational biomechanical tools. (6) Virtual surgical planning, cutting guides, and intra-operative navigation. (7) Tissue engineering: design goals, criteria, and constraints. An appreciation and understanding of these biomechanical principles will help craniofacial surgeons to facilitate intrinsic optimization and better treat complex morphological problems, helping one achieve the most favorable and durable results. The biological responses to mechanical stress are extremely important as well, but due to space constraints, they will be the subject of a separate dedicated review.