Rigid versus Resorbable Plate Fixation in Fronto-Orbital Advancement in Unicoronal Stenosis - A Retrospective Study

Abstract

Introduction: Rigid plating fixation (RPF) and resorbable plating systems (RPS) advanced the field of reconstruction in craniomaxillofacial region. However, their performance in patients, particularly the effect on bone remodeling at site of hardware placement is not much documented. This manuscript aims to compare the performance of RPF and RPS in a cohort using a retrospective audit of case records.

Methods: Archival records were searched for patients who had undergone cranial metal-RPF or RPS or combination for the correction of craniofacial deformities following inclusion-exclusion criteria. From records, data of the quality and quantity of bone formed along the site of plate fixation as compared with the adjacent site, accommodating or facilitating brain growth, and persistence of bone deformity at the site of hardware placement were collected at the end of the follow-up period. A total of 128 sites from 18 individuals (6 with exclusive metal-RPF and 12 with RPS) mean age of 7.45 ± 7.28 (Median 4; IQR of 8.88;2.6-11.5) who underwent cranial bone remodeling surgery formed the study group.

Results: There was a statistically significant difference between the RPF and PRS system at the fronto-orbital suture (P = 0.002) and coronal suture (P = 0.036) with bone quality and quantity.

Discussion: The RPF system was rigid but had a set of issues, while RPS has advantages and limitations. The qualitative difference in between the two systems is different. Due to inherent dissimilarity, the two systems cannot be interchanged and due diligence has to be exercised while deciding on the system. More prospective studies are needed to validate the findings.

Keywords: Fronto-zygomatic sutures; resorbable plates; rigid plating fixation; sonic welding; supraorbital osteotomy.

Figure 1

(a) Pre-operative view of a case of unicoronal synostosis with hypertelorism. (b) and (c) Preoperative 3D CT scan imaging. (d-g) The various sections show the images of the pre-operative planning for the calvarial segmental shift. (h-i) Intra-operative view showing rigid plate fixation (Titanium) at the frontozygomatic suture and at the upper orbital osteotomy site. (j-k) Postoperative 3DCT showing rigid plate fixation at the Frontozygomatic and supra-orbital area. (l) Postoperative view showing better aesthetic appearance

Figure 2

(a) Preoperative view of a case of Unicoronalstenosis. (b) and (c) Preoperative 3DCT scan showing synostosis at the coronal and sagittal suture. (d) and (e) 3D stereolithographic model for preoperative planning. (f) Intra operative picture shows RPF (blue arrow) at the Frontozygomatic region and RPS (Yellow arrow) at the fronto-orbital and coronal area. (g-h) Postoperative 3DCT scan showing plate fixation at the frontozygomatic and supraorbital region. (i) Postoperative view