Abstract
Introduction
Premature ossification of coronal and metopic sutures is treated by fronto-orbital remodeling. Such operations require stable fixation of the reshaped cranial bones. Currently, biodegradable plating systems are used to provide sufficient stability over the time that takes for the osteotomies to ossify. Plates that are placed traditionally on the outer surface of the cranium are often palpable and even visible through the thin overlying skin, compromising the cosmetic results of these operations. Improved aesthetics could be achieved by placing the plates endocranially.
Purpose
This study aimed to evaluate endocranial resorbable plate fixation and its clinical and radiographic results in frontal remodeling cranioplasty for plagiocephaly and trigonocephaly patients with follow-up sufficiently long for the plates to have been completely resorbed.
Methods
A poly(lactide-co-glycolide) (PLGA) resorbable plating system was used on the inner aspect of frontal bone in 27 patients treated for coronal and metopic craniosynostoses. The outcome was evaluated at follow-up visits. The mean follow-up was 79.2 months.
Results
Three patients had complications that required reoperations. None of these complications were related to the endocranial location of the plates. There were no problems with ossification of the osteotomy sites. All but one patient’s outcome was judged as good or excellent.
Conclusion
Placement of resorbable fixation on the endocranial surface of the calvarial bones is safe, stable, and results in satisfactory aesthetics without interfering with the ossification of the cranial bones.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
Ahmad N, Lyles J, Panchal J, Deschamps-Braly J (2008) Outcomes and complications based on experience with resorbable plates in pediatric craniosynostosis patients. J Craniofac Surg 19:855–860
Arnaud E, Renier D (2009) Pediatric craniofacial osteosynthesis and distraction using an ultrasonic-assisted pinned resorbable system: a prospective report with a minimum 30 months’ follow-up. J Craniofac Surg 20:2081–2086
Aryan HE, Jandial R, Ozgur BM, Hughes SA, Meltzer HS, Park MS, Levy ML (2005) Surgical correction of metopic synostosis. Childs Nerv Syst 21:392–398
Ashammakhi N, Renier D, Arnaud E, Marchac D, Ninkovic M, Donaway D, Jones B, Serlo W, Laurikainen K, Tormala P, Waris T (2004) Successful use of biosorb osteofixation devices in 165 cranial and maxillofacial cases: a multicenter report. J Craniofac Surg 15:692–701
Bergsma EJ, Rozema FR, Bos RR, de Bruijn WC (1993) Foreign body reactions to resorbable poly(L-lactide) bone plates and screws used for the fixation of unstable zygomatic fractures. J Oral Maxillofac Surg 51:666–670
Bostman O, Hirvensalo E, Makinen J, Rokkanen P (1990) Foreign-body reactions to fracture fixation implants of biodegradable synthetic polymers. J Bone Joint Surg (Br) 72:592–596
Cohen SR, Holmes RE, Meltzer HS, Levy ML, Beckett MZ (2004) Craniofacial reconstruction with a fast resorbing polymer: a 6- to 12-month clinical follow-up review. Neurosurg Focus 16:E12
Cohen SR, Mittermiller PA, Holmes RE, Broder KW (2006) Clinical experience with a new fast-resorbing polymer for bone stabilization in craniofacial surgery. J Craniofac Surg 17:40–43
Dhellemmes P, Pellerin P, Lejeune JP, Lepoutre F (1986) Surgical treatment of trigonocephaly. Experience with 30 cases. Childs Nerv Syst 2:228–232
Eppley BL (2000) Zygomaticomaxillary fracture repair with resorbable plates and screws. J Craniofac Surg 11:377–385
Eppley BL, Morales L, Wood R, Pensler J, Goldstein J, Havlik RJ, Habal M, Losken A, Williams JK, Burstein F, Rozzelle AA, Sadove AM (2004) Resorbable PLLA-PGA plate and screw fixation in pediatric craniofacial surgery: clinical experience in 1883 patients. Plast Reconstr Surg 114:850–856
Friede H, Alberius P, Lilja J, Lauritzen C (1990) Trigonocephaly: clinical and cephalometric assessment of craniofacial morphology in operated and nontreated patients. Cleft Palate J 27:362–367
Goodrich JT, Sandler AL, Tepper O (2012) A review of reconstructive materials for use in craniofacial surgery bone fixation materials, bone substitutes, and distractors. Childs Nerv Syst 28:1577–1588
Lajeunie E, Le Merrer M, Marchac D, Renier D (1998) Syndromal and nonsyndromal primary trigonocephaly: analysis of a series of 237 patients. Am J Med Genet 75:211–215
Losken A, Williams JK, Burstein FD, Cohen SR, Hudgins R, Boydston W, Reisner A, Simms C (2001) Outcome analysis for correction of single suture craniosynostosis using resorbable fixation. J Craniofac Surg 12:451–455
Matushita H, Alonso N, Cardeal DD, de Andrade F (2012) Frontal-orbital advancement for the management of anterior plagiocephaly. Childs Nerv Syst 28:1423–1427
Mesa JM, Fang F, Muraszko KM, Buchman SR (2011) Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique. Neurosurg Focus 31:E4
Meyer-Marcotty P, Alpers GW, Gerdes AB, Stellzig-Eisenhauer A (2010) Impact of facial asymmetry in visual perception: a 3-dimensional data analysis. Am J Orthod Dentofacial Orthop 137:168.e1–168.e8
Peltoniemi H, Ashammakhi N, Kontio R, Waris T, Salo A, Lindqvist C, Gratz K, Suuronen R (2002) The use of bioabsorbable osteofixation devices in craniomaxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94:5–14
Prevot M, Renier D, Marchac D (1993) Lack of ossification after cranioplasty for craniosynostosis: a review of relevant factors in 592 consecutive patients. J Craniofac Surg 4:247–254
Rhodes G (2006) The evolutionary psychology of facial beauty. Annu Rev Psychol 57:199–226
Rice DP (2008) Craniofacial sutures: development, disease, and treatment. In: Frontiers of oral biology. Karger, New York, p 35
Serlo W, Ashammakhi N, Tormala P, Waris T (2000) A new technique for correction of trigonocephaly in an infant: application of an absorbable endocranial plate. Childs Nerv Syst 16:595–597
Serlo W, Kaarela OI, Peltoniemi HH, Merikanto J, Ashammakhi NA, Lassila K, Pohjonen T, Tormala 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 35:285–292
Serlo WS, Ylikontiola LP, Vesala AL, Kaarela OI, Iber T, Sandor GK, Ashammakhi N (2007) 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
Singer S, Bower C, Southall P, Goldblatt J (1999) Craniosynostosis in Western Australia, 1980–1994: a population-based study. Am J Med Genet 83:382–387
van der Meulen J (2012) Metopic synostosis. Childs Nerv Syst 28:1359–1367
Wood RJ, Petronio JA, Graupman PC, Shell CD, Gear AJ (2012) New resorbable plate and screw system in pediatric craniofacial surgery. J Craniofac Surg 23:845–849
Acknowledgments
We thank Pasi Ohtonen, MSc, for his kind assistance with the statistical analysis used in this study and Kaisa Rahko for her beautiful drawings.
Funding
This study was supported by the Alma and K. A. Snellman Foundation, Oulu, Finland.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Salokorpi, N., Sinikumpu, JJ., Iber, T. et al. Frontal cranial modeling using endocranial resorbable plate fixation in 27 consecutive plagiocephaly and trigonocephaly patients. Childs Nerv Syst 31, 1121–1128 (2015). https://doi.org/10.1007/s00381-015-2657-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-015-2657-y