2015 HSC Section 1 Book of Articles

Facial Fractures in Children

Therefore, parents of children with condylar fractures should be counseled that growth disturbance and need for future orthognathic procedures may be needed. Addition- ally, there have been concerns about growth in the tooth-bearing portion of the mandible following rigid fixation, although recent animal studies have suggested no effect on growth. 65,66 Regardless, these concerns have stimulated interest in applying bioresorbable fixation to pediatric mandibular fractures.

RESORBABLE FIXATION

Perhaps the greatest area of current debate in the management of pediatric facial trauma is use of bioresorbable fixation hardware ( Fig. 5 ). Its widespread use in cranial vault remodeling has spurred interest in applying it to maxillofacial fractures to address the same concerns about rigid titanium fixation causing growth disturbances. Features, such as less muscular load on the hardware and rapid bony healing, make resorbable plating ideal for the pediatric population. The downsides to resorbable hardware are that they have less inherent strength, the plates are more bulky, the screws require tapping, the plates have little memory to allow for overbending, and in- flammatory reactions may occur. 57,62 Resorbable hardware has been used successfully for maxillofacial fractures in chil- dren. 50,67 Most notably, Eppley 50 reported on its use in 44 pediatric patients younger than 10 years of age with no reported implant-related complications. However, the same advantages achieved in cranial vault surgery do not necessarily translate into the face, because titanium fixation is not typically placed in regions of such rapid growth or over bony suture lines. Pediatric facial fractures are also commonly managed with judicious use of fixation and closed techniques in very young patients. Therefore, the use of resorbable fixation in maxillofacial fractures has been questioned because there is not a significant amount of data indicating that titanium fixation re- sults in maxillofacial growth restriction. 62,65,66 Furthermore, a recent Cochrane review questioned whether resorbable hardware was as effective as titanium hardware. 68 Therefore, although many surgeons are exploring the use of resorbable fixation hard- ware in pediatric facial fractures, definitive indications and recommendations for its use cannot be made at this time.

Fig. 5. Resorbable plate fixation used for a parasymphaseal mandibular fracture. ( From Eppley BL. Use of resorbable plates and screws in pediatric facial fractures. J Oral Maxillofac Surg 2005;63(3):386; with permission.)

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