Absorbable Fixation Devices for Pediatric Craniomaxillofacial Trauma: A Systematic Review of the Literature

Abstract

Background: The purpose of this study was to investigate surgical outcomes with the use of resorbable plating systems for the repair of craniomaxillofacial trauma in the pediatric population. Methods: A systematic review of the literature was performed. A descriptive analysis, operative technical data, outcomes, and postoperative complications with the use of absorbable plating systems for craniomaxillofacial trauma were included. Results: The systematic literature review identified 1264 abstracts, of which only 19 met inclusion criteria. From these 19 studies, 312 clinical cases with 443 facial fractures that were treated with absorbable fixation systems were extracted for analysis. The review identified only level III/IV (n = 17) and level V (n = 2) studies. Minor and major complications were rare, occurring in 5.45 percent (n = 17) and 3.21 percent (n = 10) of cases, respectively. The most common complications were surgical-site infections (n = 4) and plate extrusion (n = 4). Conclusions: This report is, to the authors’ knowledge, one of the first comprehensive reports on the use of absorbable plating systems for pediatric craniomaxillofacial trauma. Their analysis suggests that the use of absorbable fixation devices for pediatric craniomaxillofacial trauma is relatively safe, with a low-risk profile. Outcome studies with longer follow-up periods specifically investigating facial growth, reoperation rates, standardized surgical outcome metrics, and cost are necessary to effectively compare these fixation devices to titanium alternatives for craniomaxillofacial trauma.

Comparing maximal forces in resorbable poly-L-lactic acid and titanium plates for mandibular fracture fixation

“…When used to stabilize bone fixation reconstruction of larger defects, the radiolucent property may enable the surgeon to see the progress of the bone graft more easily compared to titanium plating devices which do not allow the full visualization of the fracture site on postoperative radiographs [12]. Additionally, resorbable plates demonstrated a decreased incidence of infection and tissue inflammation, as illustrated in Lopez et al, which detailed that only 4 of 443 resorbable plating fixation surgeries became infected compared to a study by Taylan et al, which established that 2 of 19 titanium plating fixation surgeries were infected while none of the resorbable plating systems became infected [13,14]. However, resorbable plates are not without their own complications.…”

Cranioplasty

“…Many studies have demonstrated resorbable plates to be safe in pediatric craniomaxillofacial surgery, although some reports of foreign body reaction have been described. 31,32 When rigid fixation with titanium plates is used, following osteointegration of autologous grafts hardware removal may be necessary to accommodate for pediatric calvarial growth.…”

Bioabsorbable Osteofixation Materials for Maxillofacial Bone Surgery: A Review on Polymers and Magnesium-Based Materials

“…It was concluded that, in maxillofacial surgery, the absorbable plates and screws do not show adequate safety profiles. A systematic review of the application of absorbable fixation devices in pediatric craniomaxillofacial trauma reported overall major and minor complications from 3.21% to 5.45%, and malocclusion, extrusion, infection, fistula formation, and hypoesthesia were the most common complications [ 64 ]. One of the advantages of the absorbable plate system is that no secondary operation is necessary.…”