Cellulitis related to bioabsorbable plate and screws in infraorbital rim fracture

An absorbable plating system is most commonly used to fix the bones in craniomaxillofacial surgery. Many studies focused on the advantages and clinical utility of absorbable plate and screws, but there are no reports on the complications related to these devices. From March 2004 to March 2009, 430 patients with facial bone fractures including infraorbital rim fractures underwent craniomaxillofacial surgery, in which rigid fixation was achieved with an absorbable plate and screws (Stryker, Freiburg, Germany). Five men with a delayed inflammatory reaction and infection at infraorbital rim fracture site were reviewed. Their mean age was 39 (range, 18-53 y), and all patients had maxillary sinusitis. The period from surgery to the onset of symptoms ranged from 3 to 10 weeks with a mean of 5 weeks. One patient was managed with oral antibiotics, but the other 4 patients required incisional drainage with the removal of the plate and screws because of abscess formation. The patients' symptom improved after removing the absorbable plate and screws and saline irrigation, and there was no recurrence of infection during the 12-month follow-up period. When fixing infraorbital fractures, particularly in patients with sinusitis, it is recommended to use short screws to prevent penetration of the maxillary sinus wall. In particular, one should pay attention and use shorter screws owing to the thinness of the medial infraorbital rim.