Resorbable Fixation Plates in Head and Neck Surgery

Weisberger, Edward C.; Eppley, Barry L.

doi:10.1097/00005537-199706000-00003

Cited by 40 publications

(18 citation statements)

References 23 publications

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“…In a number of studies involving PLA-PGA plates for head and neck surgery including craniofacial reconstruction and maxillary fracture fixation, no inflammatory responses were encountered. 14,15,28,33 Although no clinical evidence of inflammation or discomfort was noted in the goats by 12 weeks, histologically 50% of the PLA-PGA cage-implanted interspaces developed a foreign body granuloma, apparently elicited by PLA-PGA copolymeric debris and degradation byproducts. Whether a copolymer composition ratio with a higher PLA content, and consequently slower degradation rate, would elicit less fibroplasia or inflammation and thereby permit bone growth through the cage to achieve arthrodesis, may be worthy of future evaluations.…”

Section: Discussionmentioning

confidence: 91%

“…5,9,11,17,22,23,26,27 These resorbable polymers have also been fashioned into plates for use in neurosurgical and maxillofacial procedures. 14,15,28,33 Investigators conducting studies in animal models of the cervical spine have used dogs or goats, 13,24,25,29,32,[35][36][37][38] some with high rates of graft fracture and extrusion. 13,25 The geometrical shape of the disc space in the goat approximates…”

mentioning

confidence: 99%

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Suitability of bioresorbable cages for anterior cervical fusion

Cahill¹,

Martin²,

Hajjar³

et al. 2003

Journal of Neurosurgery: Spine

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Object. The authors conducted a pilot study to determine whether a bioresorbable intervertebral fusion device composed of 85/15 polylactide—polyglycolide (PLA-PGA) copolymer packed with bone autograft is a suitable alternative to promote arthrodesis after anterior cervical discectomy (ACD) in a caprine model. Methods. The caprine cervical spine model has been used to evaluate interbody healing and fusion after application of bone grafts and instrumentation. Whether a bioresorbable device is suitable for facilitating intervertebral bone union has not been determined. Twelve goats underwent two-level ACD and fusion; eight received bioresorbable cages packed with autologous bone, and four received autologous bone alone. Goats were maintained without an orthosis and after 12 weeks underwent physical, radiographic, and histological evaluation. Cages had structurally degraded, and two had become extruded. Stable intervertebral union developed in three (19%) of 16 cage-implanted interspaces, and one (14%) of seven bone autograft—implanted interspaces; each was judged manually to be rigid (Grade 2), radiographically to be bridged by new osseous densities (Grade 2), and histologically to have marked new bone formation (Grade 3). A primarily fibrous union, however, stabilized the cage-implanted interspaces, and eight (50%) had developed a 4 to 6—mm foreign body granuloma. These interposed soft tissues were not present in the stable autologous bone—implanted interspace, which had successfully become fused. Conclusions. Interbody cages composed of 85/15 PLA-PGA copolymer contributed to a stable fibrous union, degraded, and produced granuloma after 12 weeks. Additional evaluations are necessary to determine whether other copolymer mixtures, or other bioresorbable materials, can contribute to an arthodesis without deleterious consequences.

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Section: Discussionmentioning

confidence: 91%

mentioning

confidence: 99%

Suitability of bioresorbable cages for anterior cervical fusion

Cahill¹,

Martin²,

Hajjar³

et al. 2003

Journal of Neurosurgery: Spine

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“…Metallic plates and screws have migrated intracranially and have even penetrated the dura in some children [19]. Concern over these complications led to the development of plates and screws which absorb over approximately 9–12 months [13, 20]; however, granuloma or sterile abscess formation has been observed in association with some of the absorbable plates [19]. …”

Section: Discussionmentioning

confidence: 99%

Cranial Bone Fixation in Infants and Children

Winston

Wang

1999

Pediatr Neurosurg

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A technique is described for fixing cranial bone flaps with absorbable sutures and bone shims. This technique is a cost-efficient method of rapidly achieving rigid structural stability with excellent cosmetic results. The kerf created by the craniotome is bridged at multiple sites by bone chips harvested from the inner edge of the bone flap. Solid bony union is documented on histopathological analysis. The technique requires no special tools and avoids the problems associated with the use of plates, screws and wire.

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“…1,4,6,10,11) Absorbable plates may solve some of these problems, but are expensive and carry the risk of granuloma and sterile abscess formation. 2,9) Modified techniques of bone flap fixation without artificial materials, such as bridged craniotomy 5) and insertion of bone chips as shims, 10) provide satisfactory results, but require high levels of technical skill.…”

Section: Introductionmentioning

confidence: 99%

Supratentorial Craniotomy Using a Threadwire Saw -Technical Note-

Shimizu

Miyazaki

Suzuki

et al. 2008

Neurol. Med. Chir.(Tokyo)

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An alternative technique for cutting the bone flap in supratentorial craniotomy uses a threadwire saw (T-saw), originally developed for spinal surgery. After placing a burr hole at each corner of the intended craniotomy, osteotomy is performed between adjacent burr holes using a craniotome, leaving a bony bridge of approximately 1/3 of the length of the osteotomy. The T-saw is introduced between adjacent burr holes through the epidural space and the bridge is cut with reciprocating strokes. The narrow beveled cut reduces the bone gap for fitted bone flap fixation. On closure, the bridge firmly supports the flap and only sutures are needed for fixation. A minimal amount of filler is required to fill the bone gap. Successful bone flap fixation was obtained in more than 100 cases. No technique-related complications such as dural laceration or flap displacement occurred. Osteotomy using a T-saw was somewhat timeconsuming, but cutting efficiency was improved with a Diamond T-saw, featuring a section of cable covered with diamond particles. This method is ideal for bone cuts in cosmetic cranioplasty; is easy and safe to perform, is inexpensive, and avoids the need for flap fixation with metal devices.

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Resorbable Fixation Plates in Head and Neck Surgery

Cited by 40 publications

References 23 publications

Suitability of bioresorbable cages for anterior cervical fusion

Suitability of bioresorbable cages for anterior cervical fusion

Cranial Bone Fixation in Infants and Children

Supratentorial Craniotomy Using a Threadwire Saw -Technical Note-

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