Skip to main content
SpringerLink
Log in

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

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

References

  1. Losee JE, Mason AC (2005) Deformational plagiocephaly: diagnosis, prevention, and treatment. Clin Plast Surg 32(1):53–64

    Article  PubMed  Google Scholar 

  2. Serlo W, Ashammakhi N, Törmälä P, Waris T (2000) Case report: a new technique for correction of trigonocephaly in an infant: application of an absorbable endocranial plate. Childs Nerv Syst 16:595–597

    Article  PubMed  CAS  Google Scholar 

  3. Fiala T, Novelline R, Yaremchuk M (1993) Comparison of CT imaging artefacts from craniomaxillofacial internal fixation devices. Plast Reconstr Surg 92(7):1227–1232

    PubMed  CAS  Google Scholar 

  4. Fiala T, Paige K, Davis T, Campbell T, Rosen B, Yaremchuk M (1994) Comparison of artefact from craniomaxillofacial internal fixation devices: magnetic resonance imaging. Plast Reconstr Surg 93(4):725–731

    Article  PubMed  CAS  Google Scholar 

  5. Eppley B, Sparks C, Herman E, Edwards M, McCarty M, Sadove M (1993) Effects of skeletal fixation on craniofacial imaging. J Craniofac Surg 4(2):67–73

    Article  PubMed  CAS  Google Scholar 

  6. Eppley B, Sadove M (1995) A comparison of resorbable and metallic fixation in healing of calvarial bone grafts. Plast Reconstr Surg 96(2):316–322

    Article  PubMed  CAS  Google Scholar 

  7. Habal M, Pietrzak W (1999) Key points in the fixation of the craniofacial skeleton with absorbable biomaterial. J Craniofac Surg 10(6):491–499

    PubMed  CAS  Google Scholar 

  8. Eppley B, Reilly M (1997) Degradation characteristics of PLLA-PGA bone fixation devices. J Craniofac Surg 8(2):116–120

    Article  PubMed  CAS  Google Scholar 

  9. Eppley B, Prevel C (1997) Nonmetallic fixation in traumatic midfacial fractures. J Craniofac Surg 8(2):103–109

    PubMed  CAS  Google Scholar 

  10. Tiainen J, Soini Y, Törmälä P, Waris T, Ashammakhi N (2004) Self-reinforced polylactide-polyglycolide 80/20 screws take more than 1 1/2 years to resorb in rabbit cranial bone. J Biomed Mater Res (Appl Biomat) 70B(1):49–55

    Article  CAS  Google Scholar 

  11. Ylikontiola LP, Ashammaki N, Törmälä P, Sundquist K, Sàndor GKB (2004) Self-reinforced bio-absorbable polylactide (SR-PLD/LA) 70/30 miniplates and miniscrews are reliable for fixation of anterior mandibular fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont 97(3):312–317

    Article  Google Scholar 

  12. Weisberger E, Eppley B (1997) Resorbable fixation plates in head and neck surgery. Laryngoscope 107:716–719

    Article  PubMed  CAS  Google Scholar 

  13. Wiley RC, Sarver DR (1993) Method for heating biocompatible implants in a thermal packaging line. US Patent 5,263,991, 23 Nov 1993

  14. Tschakaloff A (1994) Surgical system. US Patent 5,290,281, 01 Mar 1994

  15. Piettrzak W, Sarver D, Bianchini S, D’Alessio K (1997) Effect of simulated intraoperative heating and shaping on mechanical properties of a bioabsorbable fracture plate material. J Biomed Mater Res (Appl Biomater) 38:17–24

    Article  Google Scholar 

  16. Eppley B, Sadove M (1992) Effects of resorbable fixation on craniofacial skeletal growth: A pilot experimental study. J Craniofac Surg 3(4):190–196

    Article  PubMed  CAS  Google Scholar 

  17. Eppley B, Sadove M (1994) Effects of resorbable fixation on craniofacial skeletal growth: modifications in plate size. J Craniofac Surg 5(2):110–114

    Article  PubMed  CAS  Google Scholar 

  18. Montag M, Morales L, Daane S (1997) Bioabsorbables: their use in pediatric craniofacial surgery. J Craniofac Surg 8(2):100–102

    Article  PubMed  CAS  Google Scholar 

  19. Goldstein J, Quereshy F, Cohen A (1997) Early experience with biodegradable fixation for congenital pediatric craniofacial surgery. J Craniofac Surg 8(2):110–115

    PubMed  CAS  Google Scholar 

  20. Kumar A, Staffenberg D, Petronio J, Wood R (1997) Bioabsorbable plates and screws in pediatric craniofacial surgery: a review of 22 cases. J Craniofac Surg 8:97–99

    Article  PubMed  CAS  Google Scholar 

  21. Enislidis G, Pichorner S, Kainberger F, Ewers R. (1997) Lactosorb panel and screws for repair of large orbital floor defects. J Craniomaxillofac Surg 25(6):316–321

    PubMed  CAS  Google Scholar 

  22. Rinehart G, Pittman T (1998) Growing skull fractures: strategies for repair and reconstruction. J Craniofac Surg 9(1):65–72

    Article  PubMed  CAS  Google Scholar 

  23. Tharanon W, Sinn D, Hobar C, Sklar F, Salomon J (1998) Surgical outcomes using bioabsorbable plating systems in pediatric craniofacial surgery. J Craniofac Surg 9(5):441–444

    Article  PubMed  CAS  Google Scholar 

  24. Goldstein JA (2001) The use of bioresorbable material in craniofacial surgery. Clin Plast Surg 28(4):653–659

    PubMed  CAS  Google Scholar 

  25. Imola MJ, Hamlar DD, Shao W, Chowdhury K, Tatum S (2001) Resorbable plate fixation in pediatric craniofacial surgery: long-term outcome. Arch Facial Plast Surg 3(2):79–90

    Article  PubMed  CAS  Google Scholar 

  26. Cohen SR, Holmes RE, Meltzer HS, Nakaji P.(2002) Immediate cranial vault reconstruction with bioresorbable plates following endoscopically assisted sagittal synostectomy. J Craniofac Surg 13(4):578–582

    Article  PubMed  Google Scholar 

  27. Serlo W, Ashammakhi N, Lansman S, Törmälää P, Waris T (2003) A new technique for correction of trigonocephaly using bioabsorbable osteofixation tacks and plates and a novel tack-shooter. J Craniofac Surg 14(1):92–96

    Article  PubMed  Google Scholar 

  28. Spanio S, Ashammakhi N, Ilomaki J, Valimaa T, Rainer C, Waris T, Törmälä P, Ninkovic M (2002) Use of new bioabsorbable tacks and a tackshooter in cranial bone osteofixation saves operative time. J Craniofac Surg 13(5):693–696

    Article  PubMed  Google Scholar 

  29. Iera D, Haddad AJ, Sàndor GKB, Ashammakhi N (2005) Les matériels d’osteosynthèse résorbales (Bioresorebable osteofixation devices). Annales de Chirgurie Plastiques Esthétique 50:723–732

    Article  CAS  Google Scholar 

  30. Antikainen T, Pernu H, Törmälä P et al (1994) Development of the neurocranium after transsutural fixing by new, resorbable poly-l-lactide miniplates. A comparison to fixing with the common titanium miniplates. Acta Neurochir (Wien) 128:26–31

    Article  CAS  Google Scholar 

  31. Waris E, Ashammakhi N, Kelly CP, Andrus L, Waris T, Jackson IT. (2005) Transphyseal bioabsorbable screws cause temporary growth retardation in rabbit femur. J Pediatr Orthop 25(3):342–345

    Article  PubMed  Google Scholar 

  32. Ashammakhi N, Renier D, Arnaud E, Marchac D, Ninkovic M, Donaway D, Jones B, Serlo W, Laurikainen K, Törmälä P, Waris T (2004) Successful use of biosorb osteofixation devices in 165 cranial and maxillofacial cases: a multicenter report. J Craniofac Surg 15(4):692–701

    Article  PubMed  Google Scholar 

  33. Vesala AL, Kallioinen M, Törmälä P, Kellomaki M, Waris T, Ashammakhi N (2002) Bone tissue engineering: treatment of cranial bone defects in rabbits using self-reinforced poly-l,d-lactide 96/4 sheets. J Craniofac Surg 13(5):607–613

    Article  PubMed  Google Scholar 

  34. Ashammakhi N, Makela EA, Vihtonen K, Rokkanen P, Törmälä P (1995) Repair of bone defects with absorbable membranes. A study on rabbits. Ann Chir Gynaecol 84(3):309–315

    PubMed  CAS  Google Scholar 

  35. Haddad AJ, Peel SA, Clokie CML, Sándor GKB (2006) Closure of rabbit calvarial critical-sized defects using protective composite allogeneic and alloplastic bone substitutes. J Craniofac Surg 17(5):926–934

    Article  PubMed  Google Scholar 

  36. Serlo W, Kaarela OI, Peltoniemi HH, Merikanto J, Ashammakhi NA, Lassila K, Pohjonen T, Törmälä P, Waris TH (2001) Use of self-reinforced polylactide osteosynthesis devices in craniofacial surgery: a long-term follow-up study. Scand J Plast Reconstr Surg Hand Surg 35(3):285–292

    Article  PubMed  CAS  Google Scholar 

  37. Ashammakhi N, Moreira A, Gonzalez AM, Törmälä P, Jackson IT (2004) Review: new resorbable bone fixation biomaterials in craniomaxillofacial surgery: Present and future. Eur J Plast Surg 26(8):383–390

    Article  Google Scholar 

  38. Ashammakhi N, Peltoniemi H, Waris E, Suuronen R, Serlo W, Kellomaki M, Törmälä P, Waris T. (2001) Developments in craniomaxillofacial surgery: use of self-reinforced bioabsorbable osteofixation devices. Plast Reconstr Surg 108(1):167–180

    Article  PubMed  CAS  Google Scholar 

  39. Mackool R, Yim J, McCarthy J (2006) Delayed degradation in a resorbable plating system. J Craniofac Surg 17(1):194–197

    Article  PubMed  Google Scholar 

  40. Bergsma JE, De Bruijn WC, Rozema FR et al (1995) Late degradation tissue response to poly(l-lactide) bone plates and screws. Biomaterials 16:25–31

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors wish to acknowledge the invaluable efforts of Ms Marianne Forsberg in the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Surgery and Paediatrics, Division of Pediatric Surgery, Oulu University, Oulu, Finland

    Willy S. Serlo

  2. Department of Pediatrics, Division of Pediatric Surgery, Turku University, Turku, Finland

    Willy S. Serlo

  3. Department of Oral and Maxillofacial Surgery, University of Oulu, Oulu, Finland

    Leena P. Ylikontiola & George K. B. Sándor

  4. Department of Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland

    Anna-Liisa Vesala & Outi I. Kaarela

  5. Department of Pediatric Surgery, Tampere University Hospital, Tampere, Finland

    Tarja Iber

  6. The Hospital for Sick Children and Bloorview Kids Rehab, Oral and Maxillofacial Surgery, University of Toronto, Toronto, Canada

    George K. B. Sándor

  7. Regea Institute for Regenerative Medicine, University of Tampere, Tampere, Finland

    George K. B. Sándor

  8. Regenerative Medicine, Institute of Science and Technology in Medicine, Keele University, Keele, UK

    Nureddin Ashammakhi

  9. Technical University of Tampere, Tampere University of Technology, Tampere, Finland

    Nureddin Ashammakhi

  10. Department of Children and Adolescents, Division of Pediatric Surgery, BOX 23, 90029 OYS, Oulu, Finland

    Willy S. Serlo

Authors
  1. Willy S. Serlo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leena P. Ylikontiola
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna-Liisa Vesala
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Outi I. Kaarela
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tarja Iber
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. George K. B. Sándor
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nureddin Ashammakhi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Willy S. Serlo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Serlo, W.S., Ylikontiola, L.P., Vesala, AL. et al. Effective correction of frontal cranial deformities using biodegradable fixation on the inner surface of the cranial bones during infancy. Childs Nerv Syst 23, 1439–1445 (2007). https://doi.org/10.1007/s00381-007-0470-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-007-0470-y

Keywords

Search

Navigation