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• W2324011663 abstract "Sir: We wish to introduce a resorbable suture fixation technique for displaced neonatal mandibular fracture repair. A premature girl born at 33 weeks' gestation sustained a mandibular symphysial fracture after breech vaginal presentation necessitated forceps-assisted vaginal delivery of this 1800-g infant. The patient was subsequently transferred to our institution for management of her mandibular fracture. Computed tomography demonstrated a significantly displaced midline fracture at the symphysis (Fig. 1). After stabilization, she was taken to the operating room for open reduction and internal fixation. The airway was managed by means of oral intubation, with suture ligation of the endotracheal tube supplemented by adhesive tapes. The inferior border of the mandible was exposed by lower buccal sulcus incision and the fracture was then reduced (Fig. 2, above). Because the fracture site was through a growth plate, only very limited curettage was performed. A 1.1-mm hole was drilled into the inferior border of the fractured fragment and reduction was achieved with a single 3-0 polydioxanone suture (Fig. 2, below). The mentalis muscle was reattached using 4-0 Vicryl suture (Ethicon, Inc., Somerville, N.J.) and the buccal sulcus incision was closed. The patient did well postoperatively, tolerating oral feeding of formula diet with good weight gain.Fig. 1.: Three-dimensional computed tomographic reconstruction.Fig. 2.: Exposure of mandibular fracture (above) with subsequent suture fixation (below).Neonatal mandibular fractures, especially those resulting from traumatic obstetric delivery, are rare. Prolonged second stage of labor, midforceps delivery, shoulder dystocia, surgeon inexperience, and birth weight over 4000 g are risk factors for traumatic obstetric delivery.1,2 Interosseous and circumferential metallic wiring was largely used for repair of the neonatal mandibular fractures as reported by Vasconcelos et al.1 Although it provides an excellent reduction of the fracture, subsequent removal of hardware is necessary. In addition, these metallic implants can cause growth restriction when deployed in immature cases, necessitating removal after achieving sufficient fracture healing. Implant extrusion and allergic reactions are other sources of morbidity for the neonatal patient.3 Using resorbable suture fixation eliminates the need for subsequent removal and provides excellent reduction of a displaced fracture, as seen in this case. Obviously, the residual interfragmentary strain is higher with sutures. However, the key question is whether it is enough to prevent redisplacement while healing is taking place. Laster et al. described memory shape nickle-titanium monocortical staple fixation as a semirigid, noninvasive method of fixation that was used in a 9-month-old infant and in a 4-year-old girl, with excellent results and minimal morbidity. The staples were subsequently removed 6 months later.4 Much like staple fixation, resorbable sutures offer a minimally invasive approach to fracture fixation but without the need for subsequent removal. Given the low load demands of the neonatal mandible, rigid fixation appears unnecessary. The unpredictable growth disturbance associated with this impressionable mandible questions even the most noninvasive manipulations needed for adequate reduction and fixation. We contend that, given the minimal load associated with the neonatal mandible and its robust healing potential, minimal exposure and fixation should be used—just enough to hold the reduction while healing occurs. Overall, resorbable suture fixation appears to be a safe, effective, and minimally invasive method of fixation of neonatal mandible fractures, with minimal risk of limiting future growth. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. Nishant Bhatt, M.D. Gerald J. Khachi, M.D. Jack C. Yu, D.M.D., M.D. Section of Plastic and Reconstructive Surgery Medical College of Georgia Augusta, Ga." @default.
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• W2324011663 date "2010-11-01" @default.
• W2324011663 modified "2023-10-03" @default.
• W2324011663 title "Resorbable Suture Fixation of Neonatal Mandibular Fractures: A Novel Technique" @default.
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• W2324011663 doi "https://doi.org/10.1097/prs.0b013e3181efa6e1" @default.
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