Growth of the orbit after frontoorbital advancement using nonrigid suture vs rigid plate fixation technique.
OBJECTIVE
To demonstrate whether a measurable difference occurs on the growth of the orbit when using 2 forms of stabilization of the supra-orbital rim after upper orbital osteotomy in children with craniosynostosis. The 2 methods of fixation include sutures providing nonrigid fixation and titanium or resorbable osteosynthesis plates.


METHODS
In this prospective randomized study, the influence of the mentioned fixation materials was analyzed in a tertiary care center (university hospital). Sixteen consecutive children with craniosynostoses (trigonocephaly, brachycephaly, plagiocephaly) were included. All patients underwent bilateral frontoorbital advancement surgery. In 8 patients each, the fixation of the mobilized and reshaped supraorbital rim was carried out using either miniplates or sutures, resulting in a rigid or nonrigid fixation. By means of computed tomography scans taken preoperatively (mean age, 8months) and postoperatively (mean age, 6.5years), the development of the orbit was measured using the anterior interorbital distance, lateral orbital distance, medial orbital-wall length, lateral orbital-wall length, and medial orbital-wall protrusion. The results were compared to norm values and statistically evaluated.


RESULTS
In all patients, a long-term improvement of the orbit was achieved with absolute distances staying below norm values. The choice of the fixation material was of minor importance.


CONCLUSIONS
Sutures providing nonrigid fixation of bone flaps seem to be feasible in reaching the aims of surgery in craniosynostotic children.
Kovács
Adorján F
AF
Department of Cranio-Maxillofacial Plastic Surgery, Johann Wolfgang Goethe-University Medical School, Surgical Center, Frankfurt am Main, Germany. a.kovacs@em.uni-frankfurt.de
Sauer
Sandra N
SN
Stefenelli
Ulrich
U
Klein
Cornelius
C
D020341:Absorbable Implants; D001860:Bone Plates; D002508:Cephalometry; D002675:Child, Preschool; D003394:Craniofacial Dysostosis / Q000000981:diagnostic imaging / Q000601:surgery*; D003398:Craniosynostoses / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005624:Frontal Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009915:Orbit / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D011098:Polyglactin 910; D011184:Postoperative Period; D011446:Prospective Studies; D013536:Suture Techniques; D014025:Titanium; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D011098:Polyglactin 910; D014025:Titanium