Fronto-orbital advancement with simultaneous LeFort III-distraction

Abstract

Patients with pronounced forms of craniosynostosis often suffer from hypoplasia of the facial skeleton. Different techniques have been described to correct these malformations consisting mainly of a standardised fronto-orbital advancement to correct the neurocranium followed by a conventional LeFort III-osteotomy for the correction of the viscerocranium several months later. In order to optimise treatment, these techniques were confined into a one step procedure. This comprised a standard fronto-orbital advancement and a simultaneous LeFort III-osteotomy, followed by distraction of the facial skeleton 7 days later using a rigid external distractor (RED). Six patients have been treated with excellent functional and cosmetic results and a high rate of patients' satisfaction. Postoperatively, one patient suffered from rhinorrhoea necessitating revision of the base of the skull 7 days later. In a second patient, the RED distractor could not be fixed due to insufficient ossification of the skull 6 months after subtotal craniectomy. In another patient, partial necrosis of the calvarial skin occurred. No other significant adverse events occurred. Upto today the LeFort III advancement plus fronto-orbital advancement were always performed intraoperatively in one single step. When applying the distraction technique, the viscerocranium can be transposed much further than by conventional techniques. Beside this, using the external RED distractor, the distraction vector can be modified and adjusted according to clinical progress postoperatively. In addition, the time gap between the operation and start of distraction allows the soft tissues to reattach, probably reducing the risk of ascending infections. The combination of fronto-orbital advancement and LeFort III advancement by distraction can optimise the clinical outcome and lower the risk of ascending infections.