Midterm Follow-Up of Midface Distraction for Syndromic Craniosynostosis: A Clinical and Cephalometric Study

Abstract

Significant midface advancement can be achieved and maintained with rigid external distraction of the Le Fort III osteotomy segment (up to 24 mm), with excellent stability of the advanced midfacial skeleton.

A Novel Craniofacial Osteogenesis Distraction System Enabling Control of Distraction Distance and Vector for the Treatment of Syndromic Craniosynostosis

“…7 The advantage of external distraction devices is that they enable the distraction vector to be controlled and easy to attach and remove. On the other hand, a drawback of the external device is that its distraction distance is generally limited, 13 although there is a good report that mean distraction was 26 mm. 14 From a psychologic perspective, it is recommended not to distract to the final adult maxillary position, as suggested by others.…”

“…One issue that needs to be addressed in the future is that, when overcorrection is performed in infants, the greater the distraction distance, the bigger the difference in the vectors of the orbitale and point A becomes, 13 making it difficult to set cephalometric targets. The patients in the present study also exhibited counterclockwise rotation of the maxilla and upward migration of point A further than was desired because we gave priority to alignment of the periorbital profile including the orbitale.…”

Treatment of the Syndromic Midface

“…In this current study, we found a complete absence of any anterior maxillary growth postoperatively, further corroborating other studies showing that all forward sagittal midfacial growth ceases following midfacial osteotomies. 4,[18][19][20][21] Given that surgical dysjunction of the midface appears to halt future maxillary growth, if the surgical advancement is performed early in life, the need for one or more subsequent maxillary repositioning(s) should be expected. An analysis of the impact of the degree of advancement on the need for a repeated midfacial advancement among our patients did show that less of an overcorrection (as measured cephalometrically, an increase in sella, nasion, A-point angle of 14 degrees versus 30 degrees; p < 0.01) was associated with the need to later repeat the advancement.…”

Two-step transport-disk distraction osteogenesis in reconstruction of mandibular defect involving body and ramus

“…Distraction osteogenesis is often used to correct craniomaxillofacial bone malformations 20,21 . Transport-disk distraction osteogenesis (TDDO) has been applied clinically to reconstruct craniomaxillofacial bone defects resulting from tumor resection 9 .…”