gms | German Medical Science

Objective: Migration of titanium osteosynthesis plates and screws in the growing skull following surgical craniosynostosis corrections has been described in the literature. Most of theses patients, however, are asymptomatic. Here we present a rare complication of intraorbital screw migration five years after fronto-orbital advancement.

Methods: A six-year-old child presented with a four months history of conjunctivitis and a new abduction deficit of her left eye. Three months earlier, a conjunctival biopsy had been taken and an atypical conjunctivitis had been diagnosed. Symptoms had improved only slightly despite local therapy. Her previous history was significant for treatment of trigonocephalus by fronto-orbital advancement at the age of nine months.

Results: Apart from the abduction deficit of the left eye and the conjunctivitis, the neurological and ophthalmological status was normal. An MRI of the orbit revealed an intraorbital metal artifact with an indentation of the bulbus. Orbital CT revealed a migration of the osteosynthesis screws through the lateral bony orbit into the orbital cavity, possibly leading to a mechanical obstacle in eye abduction.

Osteosynthesis screws were removed by surgery and the eye abduction improved gradually.

Conclusions: Although migration of titanium osteosynthesis material is a well-known phenomenon, this is the first case to our knowledge of ophthalmologic complications due to screw migration following craniofacial surgery for craniosynostosis. Symptoms could be easily relieved by explantation of the osteosynthesis material. Possible ophthalmologic problems following migration of rigid osteosynthesis material could be avoided by using reabsorbable material.