Internal Distraction Resulted in Improved Patient-Reported Outcomes for Midface Hypoplasia

Hindin, David I.; Muetterties, Corbin; Lee, Justine C.; Kumar, Anand; Kawamoto, Henry K.; Bradley, James P.

doi:10.1097/scs.0000000000004109

Cited by 17 publications

(7 citation statements)

References 14 publications

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“…Curiously, some surgeons imagine a halo for 6 to 8 weeks will induce ''meaningful psychosocial stress.'' 22 However, in this series, it was not observed in any patient. In fact, just the opposite, as patients and their families experienced ''meaningful psychosocial stress diminution'' from the enhanced aesthetics and functional improvements of the surgery.…”

Section: Discussioncontrasting

confidence: 58%

Monobloc Differential Distraction Osteogenesis

Polley

Figueroa²,

Girotto

et al. 2021

Journal of Craniofacial Surgery

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Midface advancement at the monobloc level can be the seminal life event for patients with craniofacial dysostosis. Monobloc reconstruction, when planned appropriately, can simultaneously and definitively address multiple functional and aesthetic deficiencies in these patients. The application of distraction has reduced the morbidity experienced with traditional monobloc surgery. The purpose of this study is to report on the outcomes, stability, and growth in younger patients after monobloc advancement in syndromic craniosynostosis patients. The authors report a consecutive series of thirty patients with craniofacial dysostosis treated through monobloc differential distraction osteogenesis. Detailed history, photographic, and long-term radiographic data are reviewed, including a subset of patients who were skeletally immature at the time of their treatment. Differential distraction allows control of midface pitch, roll, and yaw, optimizing functional and aesthetic outcomes. There were no infectious complications requiring reoperation. The average surgical age for all patients was 12.5 years. For the 7 patients age <7 years, average age was 6 years. For all patients, the mean horizontal movement was 12 mm at nasion and 10 mm at A-point. At mean follow-up (4.8 years entire group and 6.2 years age <7 years group) a positive horizontal advancement of 1.1 mm at nasion and 0.8 mm at A-point was observed. More pronounced positive horizontal changes were seen in the age <7 years group. Monobloc differential distraction osteogenesis affords safe and precise repositioning of the midface. The advancement is skeletally stable and young patients show moderate continued growth.

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Section: Discussioncontrasting

confidence: 58%

Monobloc Differential Distraction Osteogenesis

Polley

Figueroa²,

Girotto

et al. 2021

Journal of Craniofacial Surgery

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“…The FACE-Q scales were originally developed with patients seeking aesthetic treatments but have since been used in patients with facial trauma and those undergoing major facial surgery [9,10]. However, the nose-specific questions have, to our knowledge, not yet been validated for use in patients undergoing reconstructive surgery on the nose nor has the test-retest reliability of the scale been assessed.…”

mentioning

confidence: 99%

Application of the FACE-Q rhinoplasty module in a mixed reconstructive and corrective rhinoplasty population in Finland

Homsy

Uimonen

Lindford

et al. 2021

Journal of Plastic Surgery and Hand Surgery

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The FACE-Q Rhinoplasty module is a patient-reported outcome instrument developed for the assessment of primarily aesthetic outcomes of rhinoplasty. The aim of our study was to produce a Finnish version of the instrument and validate it for use in patients undergoing nasal reconstruction as well as those treated with a rhinoplasty. Finnish versions of the FACE-Q scales Satisfaction with Nose, Satisfaction with Nostrils and Adverse Effects: Nose, were translated following established guidelines. Patients undergoing nasal resection, reconstruction or rhinoplasty in Helsinki University Hospital plastic surgery department in 2009-2019 were identified using theatre records. A total of 240 Finnish-speaking patients 18-85 years old were approached with a postal survey questionnaire. The questionnaire included the translated FACE-Q modules and those for Satisfaction with Facial Appearance, Appearance-Related Psychosocial Distress and Satisfaction with Outcome, as well as the general health-related quality of life instrument 15 D. The FACE-Q scales translated readily to Finnish. Eighty-three patients (35%) responded to the survey. Most FACE-Q scales performed well with high internal consistency (Cronbach's alphas 0.87-0.92) and repeatability. Only the Adverse Effects: Nose scale displayed poor consistency and a floor effect with 18% of the patients reporting no adverse outcomes. Answers to the Appearance-Related Psychosocial Distress scale were skewed towards no experienced stress. Answers to the other scales were normally distributed with weak correlation with 15 D dimensions. The Finnish translations of the FACE-Q Rhinoplasty scales perform well at assessing a diverse group of patients including those undergoing nasal reconstruction as well as those undergoing rhinoplasty.

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“…45,46 The majority of patients in our center undergo internal distraction which can be attributed to our institutional preference and surgeon comfort using internal devices and its inconspicuous nature when compared to the RED device. 26,38 Unfortunately, our study is limited to internal distraction only group, therefore were are no able to provide any comparison between external and internal distraction.…”

Section: Discussionmentioning

confidence: 99%

Is Le Fort I Distraction Enough to Treat Severe Midface Hypoplasia?

Goel

Fahradyan

Wolfswinkel

et al. 2021

Journal of Craniofacial Surgery

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Background: In severe cases of maxillary hypoplasia, Le Fort I distraction may be required for treatment. This study describes our experience with internal distraction devices and assesses our outcomes in patients with a negative overjet on average >15 mm. Methods: A retrospective review of patients with a history of cleft lip and/or palate who underwent Le Fort I distraction at our institution from 11/2007-11/2017 was performed. Data regarding demographics, procedural details and outcomes were collected and analyzed.Results: Twenty patients, 13 (65.0%) male and 7 (30.0%) female, were included. All (100%) patients had a history of cleft lip and/or palate and 2 (10.0%) of them had associated syndromes. All 20 patients underwent internal distraction. The average age at surgery was 17.8 years (range 15.2-20.7, SD 1.6 years). The average preoperative negative overjet was 19.27 mm (range 10-30, SD 5.63 mm). The mean total distraction length was 15.3 mm (range 0-30, SD 6.72 mm). There were no intraoperative complications, however, there were a total of 4 (20.0%) postoperative complications, 2 of which required reoperation due to device malfunction or displacement. 14 (70.0%) patients had repeat procedures to complete occlusal correction or correct relapse. Conclusions: Maxillary distraction alone was insufficient for correction of maxillary discrepancies averaging >15 mm. Instead, it's utility may be in positioning the maxilla for a more viable final advancement and fixation procedure, rather than being solely responsible for achieving normal occlusion during distraction.

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Internal Distraction Resulted in Improved Patient-Reported Outcomes for Midface Hypoplasia

Abstract: Internal and external midface distraction patients had similar patient-reported outcomes for appearance and functional improvement; however, internal device patients were more satisfied with their quality of life and their decision to undergo the procedure.

Cited by 17 publications

References 14 publications

Monobloc Differential Distraction Osteogenesis

Monobloc Differential Distraction Osteogenesis

Application of the FACE-Q rhinoplasty module in a mixed reconstructive and corrective rhinoplasty population in Finland

Is Le Fort I Distraction Enough to Treat Severe Midface Hypoplasia?

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