Said ALGAN, Harun KARADUMAN, Hakan CİNAL, Osman Enver AYDIN, Onder TAN, Murat KARA, Kerem YILMAZ

Polydioxanone suture fixation for the repair of pediatric maxillofacial fractures

Aim: Unique pattern of the pediatric facial skeleton and its fractures confers a special issue to take into account. Conservativemanagement, occlusal splints and wiring techniques are popular among pediatric facial fractures. As titanium plates require plateremoval after the fracture healing, resorbable plates have gained popularity. However, they are expensive and it may not be possibleto obtain resorbable plates in some medical facilities. This led us to question the mechanical stability and functional outcome afterfracture fixation using polydioxanone (PDS) sutures.Material and Methods: Seven children with maxillofacial fractures were included in this study. After limited sufficient dissection andperiosteal striping the fracture lines were reduced and four holes were made with a drill on preoperatively planned sites where notooth buds were projected. After that a number 2 PDS loop suture was passed through these holes in a figure of eight fashion andtied to stitches after sufficient stability and anatomic reduction.Results: No complication occurred, except for two cases that had tooth extractions.Conclusion: To sum up, PDS suture fixation in a figure of eight fashion is a feasible and cheap alternative to titanium and resorbableplate systems.

PDF

___

1. Aydin OE, Tan O, Algan S, et al. Maxillofacial fracture experiences: a review of 152 cases. Eurasian J Med 2012;44:141-3.
2. Craig R, Dufresne PNM. Pediatric Facial Injuries. In: Mathes SJ, Hentz VR, editors. Plastic Surgery. 2nd edition. Philadelphia, Elsevier 2006;381-462.
3. Dumbach J. Traction screw osteosynthesis after ramus osteotomy with resorbable osteosynthesis screws of polydioxanone (PDS)--initial results. Dtsch Z Mund Kiefer Gesichtschir 1984;8:145-8
4. Rasse M, Schober C, Piehslinger E, et al. Intra- and extra-capsular condyle fractures in the growth period. Therapy, clinical course, complications. Dtsch Zahnarztl Z 1991;46:49-51.
5. Bardach J, Kelly KM, Salyer KE. The effects of lip repair with and without soft-tissue undermining and delayed palate repair on maxillary growth: an experimental study in beagles. Plast Reconstr Surg 1994;94:343- 51.
6. Smartt JM Jr, Low DW, Bartlett SP. The pediatric mandible: II. Management of traumatic injury or fracture. Plast Reconstr Surg 2005;116:28-41.
7. Ashammakhi N, Renier D, Arnaud E, et al. Successful use of biosorb osteofixation devices in 165 cranial and maxillofacial cases: a multicenter report. J Craniofacial Surgery 2004;15:692-701.
8. Eppley BL, Sadove AM, Havlik RJ. Resorbable plate fixation in pediatric craniofacial surgery. Plastic And Reconstructive Surgery 1997;100:1-7.
9. Mackool R, Yim J, McCarthy JG. Delayed degradation in a resorbable plating system. J Craniofacial Surgery 2006;17:194-7.
10. Bergsma EJ, Rozema FR, Bos RRM, et al. Foreign body reactions to resorbable poly (L-lactide) bone plates and screws used for the fixation of unstable zygomatic fractures. J Oral and Maxillofacial Surgery 1993;51:666-70.
11. Nakamura T, Shimizu Y, Okumura N, et al. Tumorigenicity of poly L lactide (PLLA) plates compared with medical grade polyethylene. J Biomed Mater Res 1994;28:17- 25.
12. Ikävalko M, Lehto MUK. Fractured rheumatoid elbow: Treatment with souter elbow arthroplasty--A clinical and radiologic midterm follow-up study. J Shoulder Elbow Surg 2001;10:256-9.
13. Obwegeser JA. Osteosynthesis using biodegradable poly-p-dioxanon (PDS II) in Le Fort I--osteotomy without postoperative intermaxillary fixation. J Craniomaxillofac Surg 1994;22:129-37.
14. van Sterkenburg S, Brutel de la Riviere A, Vermeulen F. Sternal fixation with resorbable suture material. Eur J Cardiothorac Surg 1990;4:345.
15. Pihlajamäki H, Salminen S, Laitinen O, et al. Tissue response to polyglycolide, polydioxanone, polylevolactide, and metallic pins in cancellous bone: An experimental study on rabbits. J Orthop Res 2006;24:1597-606.
16. Landes CA, Ballon A. Indications and limitations in resorbable P(L70/30DL)LA osteosyntheses of displaced mandibular fractures in 4.5-year follow-up. Plast Reconstr Surg. 2006;117:577-87.