2015 HSC Section 1 Book of Articles

Therefore, parents of children with condylar fractures should be counseled that growth

disturbance and need for future orthognathic procedures may be needed. Addition-

ally, there have been concerns about growth in the tooth-bearing portion of the

mandible following rigid fixation, although recent animal studies have suggested no

effect on growth.

65,66

Regardless, these concerns have stimulated interest in applying

bioresorbable fixation to pediatric mandibular fractures.

RESORBABLE FIXATION

Perhaps the greatest area of current debate in the management of pediatric facial

trauma is use of bioresorbable fixation hardware (

Fig. 5

). Its widespread use in cranial

vault remodeling has spurred interest in applying it to maxillofacial fractures to

address the same concerns about rigid titanium fixation causing growth disturbances.

Features, such as less muscular load on the hardware and rapid bony healing, make

resorbable plating ideal for the pediatric population. The downsides to resorbable

hardware are that they have less inherent strength, the plates are more bulky, the

screws require tapping, the plates have little memory to allow for overbending, and in-

flammatory reactions may occur.

57,62

Resorbable hardware has been used successfully for maxillofacial fractures in chil-

dren.

50,67

Most notably, Eppley

reported on its use in 44 pediatric patients younger

than 10 years of age with no reported implant-related complications. However, the

same advantages achieved in cranial vault surgery do not necessarily translate into

the face, because titanium fixation is not typically placed in regions of such rapid

growth or over bony suture lines. Pediatric facial fractures are also commonly

managed with judicious use of fixation and closed techniques in very young patients.

Therefore, the use of resorbable fixation in maxillofacial fractures has been questioned

because there is not a significant amount of data indicating that titanium fixation re-

sults in maxillofacial growth restriction.

62,65,66

Furthermore, a recent Cochrane review

questioned whether resorbable hardware was as effective as titanium hardware.

Therefore, although many surgeons are exploring the use of resorbable fixation hard-

ware in pediatric facial fractures, definitive indications and recommendations for its

use cannot be made at this time.

Fig. 5.

Resorbable plate fixation used for a parasymphaseal mandibular fracture. (

From

Eppley BL. Use of resorbable plates and screws in pediatric facial fractures. J Oral Maxillofac

Surg 2005;63(3):386; with permission.)

Facial Fractures in Children