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Endocortical Calvarial Resorbable Plating: A Safe and Effective Technique for Bandeau Remodeling in Fronto-Orbital Advancement
Tina M. Sauerhammer, MD, Mitchel Seruya, MD, Deniz Basci, BS, Gary F. Rogers, MD, JD, MBA, MPH, Michael J. Boyajian, MD, Robert F. Keating, MD, Albert K. Oh, MD.
Children's National Medical Center, Washington, DC, USA.

BACKGROUND: Ectocortical resorbable fixation has become the standard during fronto-orbital advancement (FOA) in infants and young children. The plates dissolve slowly by hydrolysis which, in a small number of cases, can lead to sterile abscesses. In addition, they remain visible for months to years, and can leave osseous depressions even after complete resorption. Endocortical placement avoids the latter consequences, but the safety and effectiveness of this technique is undocumented. The purpose of this study was to evaluate the efficacy and safety of endocortical resorbable fixation.

METHODS: A retrospective chart review of our database was performed. All patients undergoing FOA by a single surgeon at a single institution from 1997 to 2011 were reviewed. Inclusion criteria were as follows: 1) unicoronal, bicoronal, or metopic synostosis, 2) use of endocortical resorbable plates for fronto-orbital bandeau remodeling, and 3) follow-up ≥ 1 year. Demographic data and postoperative clinical course were evaluated, in addition to reviewing computed tomography (CT) imaging when performed.

RESULTS: Seventy-three patients met the inclusion criteria. Fusion was documented in unicoronal (n=26), bicoronal (n=19), and metopic (n=28) sutures. Mean age at operation was 8.3 months (range, 2.7 to 35.5) and follow-up was 4.5 years (range, 1.0 to 9.9). Postoperative complications included hematoma (n=2), infection (n=2), wound breakdown (n=3), brain contusion (n=2), and cerebrospinal fluid leak (n=1). No sterile abscesses were documented in our series. Fifty-eight patients (80 percent) were categorized as Whitaker classification I/II and 15 patients (20 percent) Whitaker classification III/IV. Postoperative CT (mean follow-up, 4.6 years) was obtained in 34 patients (47 percent). All plates completely resorbed, and there were no bone or soft tissue irregularities in the region where the plates were placed.

CONCLUSIONS: Endocortical resorbable plating is a safe and effective method of osseous stabilization during FOA in young children.

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