Growth restriction & migration of paediatric craniomaxillofacial osteosynthesis: A scoping review
Timothy Sng1, Eng Seng Yeoh2, Fitriana3
1Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, National University Centre for Oral Health, Singapore, 9 Lower Kent Ridge Road, 119085, Singapore.
Insights
Hardware migration and growth issues after pediatric craniomaxillofacial (CMF) osteosynthesis are common, especially with titanium fixation. More research is needed to understand long-term effects and develop better solutions.
Area of Science:
- Pediatric Craniomaxillofacial Surgery
- Biomaterials in Orthopedics
- Skeletal Development
Background:
- Craniomaxillofacial (CMF) osteosynthesis is crucial for treating pediatric craniofacial anomalies.
- Concerns exist regarding hardware migration and its impact on skeletal growth in children.
- Titanium-based fixation is widely used, but its long-term effects require thorough investigation.
Purpose of the Study:
- To systematically review and map existing evidence on hardware migration and skeletal growth aberrations.
- To identify knowledge gaps in the literature concerning pediatric CMF osteosynthesis.
- To inform clinical practice and guide future research directions.
Main Methods:
- A comprehensive systematic search was conducted across major databases (PubMed, Embase, Cochrane, Scopus, Web of Science).
- Search terms focused on hardware migration and growth restriction in pediatric CMF fixation.
- A descriptive analysis was performed on eligible clinical and animal studies following PRISMA-ScR guidelines.
Main Results:
- 10 clinical and 23 animal studies were included, analyzing 183 pediatric patients.
- Hardware migration occurred in 24.6% of pediatric cases, primarily in the calvaria using titanium plates/screws.
- Growth restriction was noted with cranial suture/midfacial fixation, but mandibular growth was unaffected.
Conclusions:
- Evidence on long-term impacts of titanium fixation on pediatric CMF growth and migration is limited.
- Retrospective study designs and heterogeneous animal models contribute to knowledge gaps.
- There is a need for longitudinal studies and the development of bioresorbable fixation systems.
Objectives:
This scoping review aimed to comprehensively map the available evidence on the migration of fixation hardware and skeletal growth aberrations caused by craniomaxillofacial (CMF) osteosynthesis in the paediatric population.
Materials & Methods:
A systematic search was made in PubMed, Embase, Cochrane Library, Scopus, and Web of Science based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Search terms were tailored to captures studies addressing growth restriction and hardware migration associated with CMF fixation in children.
Results:
A total of 762 articles were identified. 10 clinical studies and 23 animal studies were eligible. Due to the nature of the studies found, only a descriptive analysis was performed. Out of 183 children, 76% of them (mean age 10.6 months) underwent CMF fixation for management of craniosynostosis. 24.6% of these patients experienced hardware migration, exclusively in the calvaria. The temporal, parietal & frontal regions were the most frequent sites for migration, with the majority of fixation being titanium plates and screws (54.1%). Most transcranial migrations were asymptomatic (77.8%) and surgical intervention was performed in 28.8% of these affected children. Amongst the animal studies, intracranial hardware migration was reported in only 2 studies. Growth restriction was observed when CMF fixation involved cranial sutures or midfacial sites (16 studies), whereas mandibular growth remained unaffected (5 studies).
Conclusion:
Overall, the evidence regarding the long-term impact of titanium-based fixation on paediatric CMF growth and transcranial migration of hardware remains limited. This is largely attributed to the retrospective nature of available clinical studies and heterogeneity of animal models. Well-designed longitudinal studies are needed to provide more robust evidence to inform clinical practice. Nevertheless, this review consolidates current findings, highlights existing knowledge gaps and underscores the need for the development of bioresorbable fixation systems in paediatric CMF surgery.
