gms | German Medical Science

Introduction: Usually metal osteosynthesis material is used for fixation of centrolateral midfacial fractures. In the 1990th copolymers of poly L-lactic acid (PLLA) and polyglycolic acid (PGA) were introduced as bioresorbable fixation devices. The product information promises high stability, prolonged degradation time and simultaneously excellent biocompatibility.

Case: In 2003 a young man with a right sided centrolateral midfacial fracture was treated surgically in our clinic. After open reposition the fractured lateral orbital margin was fixed using a PLLA-PGA plate and screws. Twenty-two month later this patient consulted us again complaining of a cosmetically disturbing, palpable mass and intermittent pain in the right lateral orbital region.

Results: The surgical exploration showed a solid whitish tumour in this area. After complete excision it was examined histopathologically. Microscopically a granulating cicatricial process with typical signs of a foreign body reaction to the implanted resorbable material was found.

Discussion: In literature foreign body reactions to PLLA-PGA osteosynthesis devices are described in 0-47%. According to the product information of the manufactures these are rare events.

For differential diagnosis of such complains one have to think of dislocated fragments, hypertrophic bony callus and osteolytic tumour. In the presented case this could be excluded.

Conclusion: When utilizing resorbable osteosynthesis materials on PLLA-PGA basis one must be aware of the specific risk of foreign body reactions especially in cosmetically outstanding locations. About this fact and its consequences the patient has to be informed strictly preoperatively.