Resorbable Versus Titanium Rigid Fixation for Pediatric Mandibular Fractures: A Systematic Review, Institutional Experience and Comparative Analysis

Abstract

Study Design: Pediatric mandible fractures mandate special consideration because of unerupted teeth, mixed dentition, facial growth and the inability to tolerate maxillomandibular fixation. No consensus exists as to whether resorbable or titanium plating systems are superior with regards to clinical outcomes. Objective: This study aims to systematically review and compare the outcomes of both material types in the treatment of pediatric mandible fractures. Methods: After PROSPERO registration, studies from 1990-2020 publishing on outcomes of ORIF of pediatric mandible fractures were systematically reviewed according to PRISMA guidelines. An additional retrospective review was conducted at a pediatric level 1 trauma center. Results: 1,144 patients met inclusion criteria (30.5% resorbable vs. 69.5% titanium). Total complication rate was 13%, and 10% required a second, unplanned operation. Complication rates in the titanium and resorbable groups were not significantly different (14% vs. 10%; P = 0.07), and titanium hardware was more frequently removed on an elective basis (P < 0.001). Condylar/sub-condylar fractures were more often treated with resorbable hardware (P = 0.01); whereas angle fractures were more often treated with titanium hardware (P < 0.001). Within both cohorts, fracture type did not increase the risk of complications, and comparison between groups by anatomic level did not demonstrate any significant difference in complications. Conclusions: Pediatric mandible fractures requiring ORIF are rare, and hardware-specific outcomes data is scarce. This study suggests that titanium and resorbable plating systems are equally safe, but titanium hardware often requires surgical removal. Surgical approach should be tailored by fracture anatomy, age-related concerns and surgeon preference.

High Adherence of Oral Streptococcus to Polylactic Acid Might Explain Implant Infections Associated with PLA Mesh Implantation

“…Contrary to our clinical experience in oral maxillofacial fracture surgery, no major difference between the two materials was pointed out [25][26][27]. However, the removal of titanium plates was found to be more frequent than the removal of PLA plates afterward [19,25,26].…”

“…In orthognathic surgery, PLA-based bioabsorbable fixation materials have no difference from titanium in terms of infection as a complication [20][21][22][23][24]. Contrary to our clinical experience in oral maxillofacial fracture surgery, no major difference between the two materials was pointed out [25][26][27]. However, the removal of titanium plates was found to be more frequent than the removal of PLA plates afterward [19,25,26].…”

Pediatric Mandibular Fractures : Insights Into Epidemiology and Treatment at Owendo Teaching Hospital

“…This positive trajectory may be attributed to the remarkable remodeling capacity of growing bones in children. However, it's important to note that this frequency is lower compared to the rates reported by several authors, which range between 88% and 100% [16,17] .…”

Rigid versus resorbable plate fixation in fronto-orbital advancement in unicoronal stenosis - A retrospective study

“…It also outlined the need for a sufficiently powered, prospective comparative study to perform a better assessment. [ 11 12 ] The same team of authors performed a systematic analysis of all published studies for paediatric mandibular fractures and identified that the material was not a major factor with regard to fractures pattern. They concluded that neither material removes the need for maxilla-mandibular fixation.…”