Alternative techniques in rigid fixation of the craniomaxillofacial skeleton

Rigid fixation techniques in pediatric craniofacial surgery have enhanced our clinical results by offering greater stabilization and control of bone grafts and osteotomized free segments of the craniofacial skeleton. A potential disadvantage of rigid fixation techniques in the growing craniofacial skeleton includes possible long-term growth restrictions, which have been demonstrated in various animal models. Our goal was to evaluate alternative fixation techniques in the growing craniofacial skeleton of the rabbit to study how altering fixation techniques affects craniofacial development. Eighty New Zealand White rabbits were used in this study. Rabbits were divided into eight groups of 10 each, and seven variant fixation techniques were used to stabilize the frontal bones after bifrontal craniectomies. In all groups except Group 1, the animals underwent a bifrontal craniectomy with orthotopic replacement of the frontal bones. Fixation for each group was as follows: Group 2, wire; Group 3, full microplate; Group 4, suture; Group 5, microplate removal at 4 weeks; Group 6, anterior plate; Group 7, posterior plate; Group 8, soft plate. It was demonstrated that long-term effects on craniofacial development in this animal model are significantly influenced by the type and location of rigid fixation hardware. Significant differences in growth of the craniofacial skeleton for the different fixation groups are presented and discussed.