title: Complications of absorbable fixation in maxillofacial surgery: a meta-analysis.
abstract: BACKGROUND
  The use of titanium during maxillofacial fixation is limited due to its palpability, mutagenic effects and interference with imaging, which lead to the requirement for subsequent removal. The use of a biologically absorbable fixation material will potentially eliminate these limitations. In this meta-analysis, we analyzed the complications of absorbable fixation in maxillofacial surgery.
  
  
  METHODS
  We performed a systematic search of PubMed, Embase, Cochrane Central Register of Systematic Reviews and Cochrane Central Register of Controlled Trials for trials published through December 2012. Data extracted from literature were analyzed with Review manager 5.0.24.
  
  
  RESULTS
  Relevant data was extracted from 20 studies (1673 participants) and revealed that patients in the absorbable group had significantly more complications than those in the titanium group (RR = 1.20; 95% CI: 1.02-1.42; P = 0.03) in all enrolled maxillofacial surgeries. For bimaxillary operation subgroup, the absorbable fixation group did not have a significant increase in complications when compared with the titanium group (RR = 1.89; 95% CI: 0.85-4.22; P = 0.12). There was no significant difference observed between the absorbable and titanium groups receiving a bilateral sagittal split ramus osteotomy (BSSRO) (RR = 1.45; 95% CI: 0.84-2.48; P = 0.18) and Le Fort I osteotomy (RR = 0.65; 95% CI: 0.34-1.23; P = 0.18). The combined results of the five trials revealed that the absorbable group had a significantly lower rate of complications compared to the titanium group (RR = 0.71; 95% CI: 0.52-0.97; P = 0.03) in fracture fixation.
  
  
  CONCLUSIONS
  This meta-analysis shows that absorbable fixation systems used for fixation in maxillofacial surgery do not have adequate safety profiles. Subgroup indicated the safety of absorbable fixation systems was superior during fracture fixation. The absorbable fixation systems tend to have a similar favorable safety profile as titanium fixation during Le Fort I, bimaxillary operation and BSSRO.
authors.affiliation: Department 2 of Cranio-maxillo-facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
authors.forename: Liya
authors.initials: L
authors.lastname: Yang
authors.forename: Meibang
authors.initials: M
authors.lastname: Xu
authors.forename: Xiaolei
authors.initials: X
authors.lastname: Jin
authors.forename: Jiajie
authors.initials: J
authors.lastname: Xu
authors.forename: Jianjian
authors.initials: J
authors.lastname: Lu
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.forename: Tian
authors.initials: T
authors.lastname: Tian
authors.forename: Li
authors.initials: L
authors.lastname: Teng
mesh_terms: D020341:Absorbable Implants / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000009:adverse effects; D005147:Facial Bones / Q000601:surgery*; D005592:Fracture Fixation / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D013515:Surgery, Oral / Q000379:methods; D014025:Titanium / Q000009:adverse effects; D055815:Young Adult
chemical_list: D014025:Titanium