The effect of tissue expanders on the growing craniofacial skeleton

Background: Tissue expansion can safely be considered one of the major advances in reconstructive plastic surgery. Reported complication rates for tissue expansion have been as low as zero and as high as 48% when expanding the head and neck region in pediatric patients.[1] Our study is to discuss the osseous effects during and after tissue expansion in children.
Materials and Methods: Thirty four expanders were implanted, 30 in scalp and 4 in face. In 4 patients, 2 expanders were used. The mean age of the patients was 3.8 years. All CT examinations (pre-expansion, post-expansion and after reconstruction) were done correspondingly with each other to be able to compare the following parameters: bone thickness and bone density under the expander; certain intracranial dimensions under the center and the edge of the expander and observing the contour of the skull in the 3D reconstruction.
Results: Variable bony changes were observed in the 30 patients, apposition at the edge of expander (Periosteal reaction) being the most frequent change, which was observed in, all except 3 patients. Bone resorption and thinning occurred in 9 patients. Inward bone displacement varied from 1 to 3 mm in two patients.
Conclusions: In spite of the reported complications like thinning and deformation of underlying bone, expansion in infants and children is safe if done with a proper preoperative planning and we prefer to delay the expansion after two years as possible.