Screw implantation in the globe: the risk of delayed hardware migration from craniofacial repair
Mohammad Ali A Sadiq1, Sanjay P Prabhu, Jeffrey A Fearon
1From the *Department of Ophthalmology, Boston Children's Hospital; †Harvard Medical School; ‡Department of Radiology, Boston Children's Hospital, Boston, Massachussetts; §The Craniofacial Center, Medical Center Dallas Hospital, Dallas, Texas; and ∥Department of Plastic Surgery, Boston Children's Hospital, Boston, Massachussetts.
Abstract:
Plating system modification has enabled the use of rigid fixation in younger patients having maxillofacial surgery. One of the common reported complications of the use of plates and screws in children is screw migration due to skeletal maturation. Ophthalmic complications due to maxillofacial surgery reported to date include oculomotor and abducens palsies, lacrimal damage and vision loss due to infection, retrobulbar hemorrhage, and compartment syndrome. We describe a complication unique to screw migration resulting in orbital fixation and near-globe rupture in a patient with Treacher Collins syndrome. We hope to alert our colleagues to the potential risk of screw and hardware migration and breakage, particularly in the setting of craniofacial surgery performed on a child before maturation of craniofacial osseous structures.
