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Published on: April 11, 2012
Fate of rigid fixation in pediatric craniofacial surgery
W E Berryhill1, F L Rimell, J Ness
1Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, USA.
Insights
Pediatric craniofacial surgery hardware, like titanium plates, can often remain without removal, minimizing risks. Complications are infrequent, with a low reoperation rate of 8% for plate removal.
Area of Science:
- Craniofacial Surgery
- Pediatric Orthopedics
- Biomaterials
Background:
- Rigid fixation is standard in adult craniofacial surgery, with hardware removal only when indicated.
- Routine hardware removal in children is common due to concerns about growth, migration, and limited data on miniplate outcomes.
Purpose of the Study:
- To evaluate the outcomes of not removing titanium miniplates in pediatric craniofacial surgery unless clinically indicated.
- To assess the incidence and types of complications associated with retained hardware in children.
Main Methods:
- Retrospective review of 121 procedures in 96 pediatric patients (average age 3.9 years) over a 5-year follow-up.
- Analysis of complications including growth disturbances, hardware migration, pain, fluid accumulation, and infection.
- Data collected on 375 titanium plates and 1944 screws from three manufacturers.
Main Results:
- Overall complication rate was 23% (27 complications in 22 patients).
- Specific complications included 6 cases of delayed/restricted growth, 4 screw migrations (none intracranial), 9 palpable plates, 3 fluid accumulations, and 2 cases of meningitis.
- The reoperation rate for hardware removal was 8%, primarily due to pain or documented growth restriction.
Conclusions:
- Titanium miniplates can be safely retained in pediatric craniofacial surgery without routine removal.
- Concerns regarding growth restriction and migration appear manageable, with a low overall complication and reoperation rate.
Abstract:
The advantages of rigid fixation in adult craniofacial surgery are well documented, and implanted hardware is not routinely removed unless specifically indicated. There is a tendency, however, to remove hardware in children because of concerns with growth restriction, plate migration, and the lack of information on the fate of miniplates when used in pediatric craniofacial surgery. It has been our practice during the past decade not to remove hardware in children unless specifically indicated. Our study included a total of 121 procedures in 96 children, with an average age of 3.9 years and an average follow-up of 5 years. We placed 375 titanium plates and 1944 screws from 3 manufacturers. Complications encountered in children with titanium plates were as follows: 5 cases of delayed growth and 1 instance of restricted growth, 4 screw migrations (none intracranial), 9 palpable plates causing pain, 3 fluid accumulations over plates, 2 cases of meningitis, and 8 instances of plate and screw removal from the above complications. Twenty-two of 96 patients (23%) had a total of 27 complications from 121 procedures (22%). There were 6 cases in which pain precipitated removal of hardware, 1 case of an excessively mobile plate, and 1 case of documented growth restriction requiring removal; therefore our overall reoperation rate for plate removal was 8%, with no intracranial plate or screw migration.
