Child's Nervous System

, Volume 23, Issue 12, pp 1439–1445

Effective correction of frontal cranial deformities using biodegradable fixation on the inner surface of the cranial bones during infancy

  • Willy S. Serlo
  • Leena P. Ylikontiola
  • Anna-Liisa Vesala
  • Outi I. Kaarela
  • Tarja Iber
  • George K. B. Sándor
  • Nureddin Ashammakhi
Original Paper

DOI: 10.1007/s00381-007-0470-y

Cite this article as:
Serlo, W.S., Ylikontiola, L.P., Vesala, AL. et al. Childs Nerv Syst (2007) 23: 1439. doi:10.1007/s00381-007-0470-y

Abstract

Purpose

Fixation of cranial bones in pediatric craniofacial surgery with biodegradable materials has developed into an accepted method. However, placing the fixation material on the outer surface of the cranial bone at the frontal cranium in infants can result in suboptimal cosmetic outcomes, as the plates and screws can be palpable. The placement of resorbable fixation devices on the inner surface of the skull would allow for less obvious fixation beneath the skin with a potentially superior cosmetic result. The authors report the use of such resorbable fixation devices on the inner or endocranial aspect of the cranium which appears to be novel.

Materials and methods

Ten patients with the mean age of 14 months (range 7–35 months) were treated with cranial remodeling using poly(lactide-co-glycolide) (PLGA) biodegradable fixation on the inner surface of the cranial bones. Five patients had trigonocephaly, four plagiocephaly, and one brachycephaly. All patients had 3D computed tomography (CT) and clinical photographs done preoperatively and postoperatively at follow-up. The outcome was judged at follow-up by clinical evaluation, photographs, 3D CT, and interview of the parents. The mean follow-up time was 3.5 years (range 0.5–6 years).

Results

The primary recovery was uneventful in all cases. No wound infection occurred, but one patient had a minor skin necrosis which required a single revision operation to correct. The cosmetic outcome was scored as excellent, good, fair, or poor. There was no case with delayed union. Seven out of ten cases were judged as excellent and three as good, none as fair or poor.

Conclusions

The use of resorbable PLGA fixation devices on the inner aspect of the skull appears to provide a satisfactory cosmetic result in this small preliminary group of pediatric patients. Further long-term study of these materials in this specific location in a larger patient group is needed.

Keywords

BiodegradableCranioplastyEndocranial

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Willy S. Serlo
    • 1
    • 2
    • 10
  • Leena P. Ylikontiola
    • 3
  • Anna-Liisa Vesala
    • 4
  • Outi I. Kaarela
    • 4
  • Tarja Iber
    • 5
  • George K. B. Sándor
    • 3
    • 6
    • 7
  • Nureddin Ashammakhi
    • 8
    • 9
  1. 1.Department of Surgery and Paediatrics, Division of Pediatric SurgeryOulu UniversityOuluFinland
  2. 2.Department of Pediatrics, Division of Pediatric SurgeryTurku UniversityTurkuFinland
  3. 3.Department of Oral and Maxillofacial SurgeryUniversity of OuluOuluFinland
  4. 4.Department of Surgery, Oulu University HospitalUniversity of OuluOuluFinland
  5. 5.Department of Pediatric SurgeryTampere University HospitalTampereFinland
  6. 6.The Hospital for Sick Children and Bloorview Kids Rehab, Oral and Maxillofacial SurgeryUniversity of TorontoTorontoCanada
  7. 7.Regea Institute for Regenerative MedicineUniversity of TampereTampereFinland
  8. 8.Regenerative Medicine, Institute of Science and Technology in MedicineKeele UniversityKeeleUK
  9. 9.Technical University of Tampere, Tampere University of TechnologyTampereFinland
  10. 10.Department of Children and Adolescents, Division of Pediatric SurgeryOuluFinland