title: Biodegradable fixation for craniomaxillofacial surgery: a 10-year experience involving 761 operations and 745 patients.
abstract: Patient acceptance, safety, and efficacy of poly-l/dl-lactic acid (PLLDL) bone plates and screws in craniomaxillofacial surgery are reported in this article. Included in the sample are 745 patients who underwent 761 separate operations, including more than 1400 surgical procedures (orthognathic surgery (685), bone graft reconstruction (37), trauma (191) and transcranial surgery (20)). The success (no breakage or inflammation requiring additional operating room treatment) was 94%. Failure occurred because of breakage (14) or exuberant inflammation (31). All breakage occurred at mandibular sites and the majority of inflammatory failure occurred in the maxilla or orbit (29), with only two in the mandible. Failures were evenly distributed between the two major vendors. PLLDL 70/30 bone plates and screws may be used successfully in a variety of craniomaxillofacial surgical applications. The advantages include the gradual transference of physiological forces to the healing bone, the reduced need for a second operation to remove the material and its potential to serve as a vehicle to deliver bone-healing proteins to fracture/osteotomy sites. Bone healing was noted at all sites, even where exuberant inflammation required a second surgical intervention.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of North Carolina, Chapel Hill, NC, USA. Tim_Turvey@dentistry.unc.edu
authors.forename: T A
authors.initials: TA
authors.lastname: Turvey
authors.forename: W P
authors.initials: WP
authors.lastname: Proffit
authors.forename: C
authors.initials: C
authors.lastname: Phillips
mesh_terms: D020341:Absorbable Implants; D000293:Adolescent; D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000737:chemistry*; D001696:Biomechanical Phenomena; D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D004337:Drug Carriers; D004868:Equipment Failure; D005147:Facial Bones / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007249:Inflammation; D019344:Lactic Acid / Q000737:chemistry*; D008297:Male; D008875:Middle Aged; D056948:Orthognathic Surgical Procedures / Q000295:instrumentation; D010027:Osteotomy / Q000295:instrumentation; D057240:Patient Preference; D011091:Polyesters; D011108:Polymers / Q000737:chemistry*; D012189:Retrospective Studies; D012449:Safety; D012886:Skull / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
chemical_list: D001672:Biocompatible Materials; D004337:Drug Carriers; D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)