Biodegradable fixation of mandibular fractures in children: Stability and early results Kaan C. Yerit, MD, DMD, a Sibylle Hainich, MD, DMD, b Georg Enislidis, MD, DMD, a Dritan Turhani, MD, a Clemens Klug, MD, a Gert Wittwer, MD, DMD, a Michael O ¨ ckher, MD, DMD, a Gerhard Undt, MD, DMD, PhD, c Christian Kermer, MD, DMD, c Franz Watzinger, MD, DMD, PhD, c and Rolf Ewers, MD, DMD, PhD, d Vienna, Austria MEDICAL UNIVERSITY OF VIENNA Objective. The aim of this study was to assess the safety and efficiency of biodegradable self-reinforced (SR-PLDLA) bone plates and screws in open reduction and internal fixation of mandible fractures in children. Study design. Thirteen patients (5 female, 8 male; mean age 12 years, range 5-16 years) were operated on various fractures of the mandible (2 symphyseal, 6 parasymphyseal, 4 body, 3 angle, 1 ramus, 2 condylar fractures). The mean follow-up time was 26.4 months (range 10.9-43.4 months). Intermaxillary fixation was applied in cases with concomitant condylar fractures up to 3 weeks. Results. Primary healing of the fractured mandible was observed in all patients. Postoperative complications were minor and transient. The outcome of the operations was not endangered. Adverse tissue reactions to the implants, malocclusion, and growth restrictions did not occur during the observation period. Conclusions. Pediatric patients benefit from the advantages of resorbable materials, especially from faster mobilization and the avoidance of secondary removal operations. Based on these preliminary results, self-reinforced fixation devices are safe and efficient in the treatment of pediatric mandible fractures. However, further clinical investigations are necessary to evaluate the long-term reliability. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:17-24) In contemporary maxillofacial surgery, biodegradable bone fixation is becoming an alternative treatment in trauma, orthognathic, and craniofacial surgery. 1-25 The fast development of new biodegradable materials expands the application to areas where a few years ago only the rigid fixation by metallic plates and screws was possible. New biomechanical properties of bio- degradable devices lead to a growing number of indications and even high load-bearing areas such as the human mandible can be treated with these new devices under certain circumstances. 8,13-17,21-24 The main advantage of internal resorbable fixation of fractures is the gradual transfer of load to the healing bone during resorption and the elimination of any secondary operation for implant removal, which is common with metallic implants. The clinical realization of these advantages has increased the interest in developing biodegradable implants, and clinical studies report on the successful use of these devices in pediatric craniofacial surgery. 10,11,19,20,25 Maxillofacial fractures are less common in children than in adults. The incidence ranges from approximately 1% in children under the age of 5 years up to 8% in children younger than 12 years of age. 26-29 Mandibular fractures are reported to belong to the most frequent facial fractures in pediatric patients. 28 The conservative approach in the treatment of maxillofacial trauma in children was common for many reasons. The presence of tooth buds and the elasticity of the pediatric bone were factors for splinting and/or intermaxillary fixation as a standard treatment of mandibular fractures in children during deciduous dentition. Open reduction and internal fixation were avoided in most cases so as not to harm the teeth. The development of microplates and miniplates made it possible to apply these fixation materials in pediatric traumatology as well. This technology offers improved initial stability but its appliance in children is limited in the mandible not only due to the above- mentioned reasons but also due to concerns over growth restrictions, stress shielding, corrosion, and palpability. Resorbable osteofixation materials promise to overcome these problems. This clinical study analyzes stability and efficiency of biodegradable self-reinforced bone plates and screws in a Resident, University Hospital of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Austria. b Resident, Clinic of Dentistry, Medical University of Vienna. c Assistant Professor, University Hospital of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna. d Professor and Head, University Hospital of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna. Received for publication Jul 11, 2004; returned for revision Oct 6, 2004; accepted for publication Nov 19, 2004. Available online 12 March 2005. 1079-2104/$ - see front matter Ó 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.tripleo.2004.11.013 17