Intracranial Migration of a Halo Pin During Distraction Osteogenesis for Maxillary Hypoplasia: Case Report and Literature Review

Abstract

Halo devices are most frequently used by orthopedic and neurosurgeons. The first reported use was by Perry and Nickel in 1959, who used a halo to immobilize the cervical spine of a poliomyelitis patient after complete fusion of the cervical spine. One of the relatively newer uses is as part of an external distraction device for stabilization and providing predictable forces to the craniofacial skeleton for distraction osteogenesis after osteotomies are performed. This is now widely used for treating maxillary hypoplasia, after being reported by Polley and Figueroa in 1997. Many of the patients that require this treatment have craniofacial abnormalities because of craniosynostosis syndromes such as Crouzon, Pfeiffer, and Apert. The common characteristic shared by these syndromes is midface recession with shallow orbits resulting in proptosis and a class III malocclusion. The procedure includes performing a Le Fort I or III osteotomy. The head frame is then secured to the skull with percutaneous pins and attached to the midface with wires. Because the device is often left in position for periods of up to 3 months, changes in the position of the pins and the device are possible. We report the case of a 19-year-old man with Crouzon’s syndrome who underwent a Le Fort III osteotomy for distraction osteogenesis, and at the time of distractor removal was found to have intracranial migration of 1 of the halo pins with dural penetration.