Fronto-facial monobloc distraction in syndromic craniosynostosis. Three-dimensional evaluation of treatment outcome and facial growth

Correcting the Typical Apert Face

“…26 Other groups have described their experience with treatment of the midface deformity in Apert syndrome using Le Fort III osteotomy 9 -24 or Le Fort III midface distraction, 8,9,[27][28][29][30][31][32] dual Le Fort III minus I and Le Fort I midface distraction, 33 monobloc distraction, [22][23][24][25][26][27][28][29][30][31][32][33][34] or facial bipartition. 27,28,34,35 One group describes performing facial bipartition concomitantly with monobloc advancement in seven patients (average age, 7.5 to 2.7 years; range, 6 to 13 years), and one patient had facial bipartition later in adolescence at 18 years of age following prior monobloc advancement at age 5. 27 Posnick et al state that "A Le Fort III osteotomy is virtually never adequate for an ideal correction of the residual upper and midface deformity of Apert syndrome" and that when using the facial bipartition approach, a more normal arc of rotation of the midface complex is achieved with the midline split.…”

10 Distraction Osteogenesis

“…The amount of advancement of midface that can be achieved by distraction osteogenesis is generally greater than the amount obtained by conventional osteotomies such as Le Fort III and monobloc osteotomy. [60] Long-term follow ups of syndromic patients who underwent maxillary-midface advancement with distraction osteogenesis have proved the stability of the results. [59], [61], [62] …”

CT Imaging Findings after Craniosynostosis Reconstructive Surgery

“…Compared to conventional advancement, fronto-facial monobloc advancement with distraction osteogenesis provides greater advancement and decreased morbidity, blood loss, and operative time. When comparing pre- and postoperative CT imaging of patients with syndromic craniosynostosis, this technique has been shown to increase the intracranial volume on average by 11% and upper airway volume by 85%, with dramatic resolution of functional complications [15]. Furthermore, monobloc advancement can increase the orbital volume by approximately 50% and thus diminish exorbitism (Fig.…”