OBJECTIVES: This scoping review aimed to comprehensively map the available evidence on the migration of fixation hardware and skeletal growth aberrations caused by craniomaxillofacial (CMF) osteosynthesis in the paediatric population. MATERIALS & METHODS: A systematic search was made in PubMed, Embase, Cochrane Library, Scopus, and Web of Science based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Search terms were tailored to captures studies addressing growth restriction and hardware migration associated with CMF fixation in children. RESULTS: A total of 762 articles were identified. 10 clinical studies and 23 animal studies were eligible. Due to the nature of the studies found, only a descriptive analysis was performed. Out of 183 children, 76% of them (mean age 10.6 months) underwent CMF fixation for management of craniosynostosis. 24.6% of these patients experienced hardware migration, exclusively in the calvaria. The temporal, parietal & frontal regions were the most frequent sites for migration, with the majority of fixation being titanium plates and screws (54.1%). Most transcranial migrations were asymptomatic (77.8%) and surgical intervention was performed in 28.8% of these affected children. Amongst the animal studies, intracranial hardware migration was reported in only 2 studies. Growth restriction was observed when CMF fixation involved cranial sutures or midfacial sites (16 studies), whereas mandibular growth remained unaffected (5 studies). CONCLUSION: Overall, the evidence regarding the long-term impact of titanium-based fixation on paediatric CMF growth and transcranial migration of hardware remains limited. This is largely attributed to the retrospective nature of available clinical studies and heterogeneity of animal models. Well-designed longitudinal studies are needed to provide more robust evidence to inform clinical practice. Nevertheless, this review consolidates current findings, highlights existing knowledge gaps and underscores the need for the development of bioresorbable fixation systems in paediatric CMF surgery.
Sng et al. (Wed,) studied this question.