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The effect of rigid internal fixation on cranial growth
J I Resnick1, B M Kinney, H K Kawamoto
1Division of Plastic Surgery, University of California School of Medicine, Los Angeles.
Insights
Miniplate and screw fixation may hinder craniofacial growth in pediatric patients. Surgeons should cautiously consider these devices due to potential secondary growth disturbances in young patients.
Area of Science:
- Craniofacial surgery
- Pediatric orthopedics
- Biomedical engineering
Background:
- Rigid internal fixation is common for adult facial fractures.
- Its application in pediatric craniofacial surgery is increasing.
- The impact on pediatric craniofacial growth remains unexamined.
Purpose of the Study:
- To investigate the effects of miniplate and screw fixation on craniofacial growth in a pediatric model.
- To assess potential growth disturbances caused by rigid internal fixation devices.
Main Methods:
- A rabbit model (6-week-old) was used for the experiment.
- Miniplates were surgically placed across the right coronal suture.
- Calvarial growth was measured using direct osteometry on dry skull preparations.
Main Results:
- A significant reduction in growth was observed across the plated coronal suture.
- Adjacent bones also exhibited reduced growth compared to the control group.
- The fixation devices negatively impacted craniofacial development.
Conclusions:
- Miniplate and screw fixation can lead to secondary growth disturbances in pediatric patients.
- The use of these rigid fixation devices in pediatric craniofacial surgery warrants caution.
- Further research is needed to understand long-term effects and alternatives.
Abstract:
As the use of rigid internal fixation of the facial skeleton has become routine in adults, many craniofacial surgeons have expanded its use to the pediatric population. The effects of miniplate and screw fixation on subsequent craniofacial growth, however, have not been examined. Using 6-week-old rabbits as an experimental model, miniplates were placed across the right coronal suture. Calvarial changes were measured by direct osteometry on dry skull preparations. Compared with the control group, a significant reduction in growth was noted across the plated suture and adjacent bones. Because secondary growth disturbances can be produced with the use of these fixation devices, their use in the pediatric population should be viewed cautiously.