Le Fort III Advancement Osteotomy in the Growing Child Affected by Crouzon's and Apert's Syndromes: Presurgical and Postsurgical Growth

Abstract

This is a longitudinal cephalometric study of patients with craniofacial synostosis (Crouzon's and Apert's) syndromes who underwent Le Fort III advancement during early childhood. The objectives of the study were to quantify presurgical growth, surgical results, and surgical stability as well as long-term postsurgical growth. Of the 31 patients operated on during their growth period (less than 10 years of age), 17 had sufficient records to be included in the study: at infancy, before the Le Fort III osteotomy (average age=7.3 years, range: 4.8-10 years), and immediately after surgery. Ten of the patients were followed radiographically long term for an average of 6.1+/-2.7 years (range: 4.5-10.8 years). The presurgical abnormal midfacial vertical growth pattern was accurately described with a progressive class III discrepancy and an increasing exophthalmos. Remarkable postoperative stability of the maxillary segment was observed. After surgery, growth of the midface was measured, together with minimal, if any, anterior growth, similar to the presurgical growth pattern and rate. No actual detrimental or beneficial effect of surgery on subsequent growth was seen. This study quantitatively confirms that the standard Le Fort III osteotomy is a stable and effective but generally not definitive procedure in childhood. This study might also serve as a control sample to compare with groups of patients undergoing distraction osteogenesis to verify the actual advantages and shortcomings of this alternative technique.

Additional orthognathic surgery following Le Fort III and monobloc advancement

“…The timing 15 . Due to a diminished syndrome-related intrinsic anterior growth potential of the midface, little forward growth is expected postsurgically 1,7,11,14 . This, together with the unaffected growth of the mandible, might cause (pseudo-)relapse at an older age requiring additional (orthognathic) surgery.…”

“…In addition, the literature reports a severely diminished intrinsic horizontal growth potential of the midface in SCS patients regardless of surgery 7,11,14 . Continuing growth of the mandible may cause pseudorelapse so some degree of overcorrection in growing patients is advised.…”

“…Frequently, additional orthognathic surgery is indicated later. Various suggestions are reported in literature 2,7,12,14 . There are no clinical guidelines regarding the ideal timing and planning of these surgical procedures and Int.…”

Skeletal and dental stability of segmental distraction of the anterior mandibular alveolar process. A 2-year follow-up

“…The applications comprise mandibular lengthening 20 or widening 4 , reconstruction of the alveolar process for implant placement 2 , DOG for bone transport after trauma or tumour resection for reconstruction of segmental defects or a neocondyle 15 , maxillary DOG for unilateral and bilateral cleft patients 16 , and midfacial or cranial DOG for different types of craniosynostosis 9 .…”

Análise da retrusão do terço médio da face e dismorfologia orbital em crianças portadoras das Síndromes de Apert e Crouzon

“…While surgeons achieve good outcomes using a standard Le Fort despite there being no direct surgical remodeling of the orbital area (24). This is thought to be secondary to remodeling of the orbit following midface advancement (24,85). Still, the full mechanism by which this apparent remodeling occurs remains uncertain.…”