Rigid Fixation of the Pediatric Facial Skeleton

Pediatric facial fractures are uncommon, and the majority is able to be managed with closed reduction or conservative therapy. Operating on the developing facial skeleton carries inherent risks of growth restriction and permanent injury to ossification centers and intrabony anatomy. Both resorbable (PGA/PLA) and nonresorbable (titanium) hardware are safe and appropriate in children. Resorbable implants are thought to reduce long-term complications but nonresorbable implants offer a more robust and rigid fixation. Most surgeons opt to retrieve nonresorbable hard-ware after 2 to 3 months of healing due to migration concerns. Growth restriction from internal fixation has multiple contributions. Properly placed hardware that respects natural suture lines is not thought to significantly inhibit growth. As materials science progresses, manufacturers can hopefully get closer to developing the ideal implant that combines the benefits of both fixation options.