OBSERVATIONS ON THE USE OF RIGID FIXATION FOR CRANIOFACIAL DEFORMITIES IN INFANTS AND YOUNG-CHILDREN

With the introduction of smaller plating systems, many surgeons have a dopted their use for craniofacial procedures in infants and small chil dren. We have encountered some previously undescribed problems associa ted with the use of plates and screws in infants and children. These p roblems can be classified into three general areas: 1) Plate displacem ent. This occurs after placement of the metal plates on the outside of the infant calvaria. With subsequent growth, these plates and screws may be found along the inner colter of the skull with screw points emb edded through dura. 2) Plate and screw isolation. In certain locations in young children, plates placed on the outer cortex of bone may late r be found to be more prominent, isolated on a peninsula of bone. 3) P late placement. We have also encountered plates that have been placed along the inner cortex of the skull during a previous operative proced ure. This makes subsequent surgery extremely difficult and may increas e the risk for secondary surgery. We propose that a previously describ ed model for growth, involving areas of bony resorption and deposition , may be responsible for the observed plate displacement.