A comparative in fixation of the craniofacial skeleton using resorbable material

Abstract

Background: Application of resorbable materials in craniofacial surgery offers many advantages compared with conventional materials such as titanium which is used in the reduction of incidence of complications like extrusion, intracranial migration or translocations of the implant, also there is no restriction on the skeletal growth as well as no distortion in plain radiographic and CAT scan studies. Materials and Methods: It was a prospective, sequential, comparative and open study carried out between October of 2002 and February of 2004 among patients of the Clinic of Craniofacial Surgery at ISSEMYM Medical Center in Metepec, Mexico. The patients were sequentially assigned either to group I in which LactoSorb ; (Biomet microfixation) resorbable screws and miniplates of 1.5 mm, 2.0 mm and 2.5 mm sizes (made up of 82% PLLA and 18% PGA) were used; and to group II in which titanium screws and miniplates of the same sizes were used. All patients were preoperatively documented with clinical examination, clinical photographs and CAT scan. Results: A total of 100 patients were included with 50 patients in each group. In group I, 40 patients (80%) with facial fractures were operated, of which 18 were simple maxillary fractures, 11 were fractures of orbitomalar complex, 7 panfacial fractures, 2 fractures of frontal sinus and 2 mandibular fractures; in 5 patients (10%) with malocclusion, some kind of orthognathic surgery was performed, 4 maxillary osteotomies and one maxillo-mandibular osteotomy were performed; and the remaining 5 patients (10%) were subjected to some advanced craniofacial surgery procedure, in one patient with Apert's syndrome a fronto-orbital advancement was performed, there were 3 patients with hypertelorism in whom orbital medialization was undertaken in two cases and facial bipartition in one; the remaining case was a Treacher Collins patient in which a orbital reconstruction using monocortical parietal bone was performed. In the age range of 6-55 years with an average of 30.5-year-old in these procedures, a total of 196 miniplates were placed. Conclusions: The results of our study confirm data reported by previous descriptive studies about the systems for resorbable fixation. We consider that the present method of resorbable fixation is a viable and safe option for the management of patients who require some type of fixation of the craniofacial skeleton.