Le Fort III Osteotomy Research Articles

Multidisciplinary Rehabilitation Approach to the Maxillo-Facial Complications of Crouson’s Disease: Case Report and Review

Background: Craniofacial anomalies present a challenge to all health care practitioners since they necessitate long-term team follow-up, which is difficult to achieve outside of a major center where craniofacial anomalies teams normally collaborate. Objectives: The current review with an illustrative case focuses on the representation and review of Crouzon syndrome and its maxillofacial implications. Review of different varieties of gene mutations that produce craniosynostosis syndromes were discussed and focused on seven clinically distinct craniosynostosis syndromes that are precipitated by the mutation in one or more of the fibroblast growth factor receptors genes which affected the maxillofacial region. Case presentation: A complete clinical and radiographic case scenario of a patient suffering from Crouzon syndrome was presented, and discussion of the various disciplines and techniques used along the way to achieve the best results, as well as how team collaboration and patient compliance led to the best results were represented. The presented case was treated with orthodontic treatment, Le Fort-I osteotomy, and Le Fort-III osteotomy with extraoral distraction osteogenesis. Conclusion: The combination of different orthognathic surgery alternatives (Le Fort-III and Le Fort-I) with distraction osteogenesis and orthodontic treatment produced excellent outcomes with few complications, and the patient was extremely satisfied and cooperative. Early and thorough team-based care for Crouzon syndrome patients should be accessible at specialized craniofacial centers.

Rigid External Distractor-Aided Advancement After Simultaneously Performed LeFort-III Osteotomy and Fronto-Orbital Advancement.

Due to the complex development of the craniofacial skull, corrective surgery is a major challenge for patients with severe craniofaciostenosis. Although fronto-orbital advancement and simultaneous LeFort-III osteotomy in combination with distraction osteogenesis have been reported as a safe and successful method to obtain good esthetic and functional results, there is a lack of studies evaluating this method.Our retrospective study included 12 patients with syndromic craniofaciostenosis, who were primarily treated at our department in accordance with a standardized treatment protocol, consisting of a simultaneous fronto-orbital advancement with LeFort-III osteotomy in combination with a rigid external distractor (RED-II). Distraction distance, duration of operation, postoperative complications, perioperative hemoglobin concentration, esthetic outcome, and the subjective Whitaker Scale were used to evaluate the success of our surgical method.The esthetic outcome of all of our patients was assessed as good. Furthermore, the surgical outcome was assigned I for 11 patients and II for 1 patient, who suffered from wound healing disturbance at the left temporal site, which required revision 2 weeks postoperatively. The mean skeletal advancement of the midface was 16.4 mm, ranging from 12 to 20 mm.Our standardized treatment protocol, consisting of fronto-orbital advancement in combination with LeFort-III osteotomy and application of a rigid external distractor device (RED-III) for patients with severe syndromic craniofaciostenosis, goes along with low infection rates and more predictable and precise esthetic and functional outcomes than the conventional surgical technique without distraction osteogenesis.

0890 INDIVIDUALIZED THERAPY FOR TREATING OBSTRUCTIVE SLEEP APNEA IN PEDIATRIC CROUZON SYNDROME PATIENTS

Pediatric patients with Crouzon syndrome have great possibilities in suffering from obstructive sleep apnea (OSA), which is mainly due to midfacial hypoplasia and facial deformities. For most patients, a multi-disciplinary and sequential treatment plan is necessary to make for Crouzon syndrome often has different phenotypes of different severity in OSA and facial deformities. Typical patients were selected in this study to illustrate the necessity of individualized therapy for treating OSA. In the study, four Crouzon syndrome children of different severity in suffering from OSA and maxillofacial deformities were introduced. Detailed information in individualized treatment options was given including clinical manifestations, radiological findings, polysomnography detectings and treatment combinations. Based on the above findings, different but effective treatment options for these children’s OSA problems were adopted, either by surgeries including distraction osteogenesis and craniomaxillofacial surgeries with or without tonsillectomy, or by noninvasive continuous positive airway pressure (CPAP) therapy. Patient 1 was performed with LeFort IIIosteotomy and external distraction osteogenesis. Patient 2 was given LeFort IIIosteotomy and external distractor fixation and concurrent bilateral mandibular body osteotomy and internal distractor fixation for bimaxillary distraction. Patient 3 received LeFort I osteotomy for maxillary advancement with concurrent bilateral tonsillectomy. Differently, patient 4 with mild OSA disturbance adopted initial continuous positive airway pressure (CPAP) with good adherence and body development. Six years later, he began orthodontic treatment for preparing for orthognathic surgery. Recently bimaxillary surgery was performed on him to enlarge upper airway anatomically as well as improve facial profile. Follow-up studies showed problems of OSA and nocturnal hypoxia of those four patients were all alleviated greatly, as well as maxillofacial deformities. Combined with preoperative and postoperative orthodontics, patient 1 and 4 also got optimal results in better facial profile and dental occlusion. Thus, given Crouzon patients had great possiblilities in suffering from OSA and hypoxia problems, individualized therapy should be made and performed carefully to obtain optimized treatment results based on adequate clinical evaluations and patients’ conditions including age, disease severity and esthetic considerations. This work was supported by the National Natural Science Foundation of China (Grant number: 81470786).

Application of Le Fort Ⅲ osteotomy with minimal invasive approach in the treatment of midfacial hypoplasia

To describe a minimal invasive approach in the Le Fort Ⅲ osteotomy procedure. 33 cases with midfacial hypoplasia were treated by Le Fort Ⅲ osteotomy.Incisions were performed with minimal invasive approach,through lower eyelid,intraoral and upper eyelid crease or medial part of eyebrow instead of coronal incision.After the completion of osteotomy,distraction osteogenesis or orthognathic procedures were followed. The midfacial segments achieved enough advancement without obvious relapse.Bleeding and operative time were reduced compared with coronal approach.No obvious scar was left. The Le Fort Ⅲ osteotomy procedure could be successfully performed through minimal approach with steady results and minimal scars.

Experience of midfacial distraction osteogenesis in upper airway stenosis

To investigate the therapeutic effects of upper airway stenosis after Le Fort III osteotomy and midfacial distraction osteogenesis (DO). Eleven cases (age, 5-16 yrs) with severe midface dysostosis complicated with exophthalmos, anterior crossbite and upper airway stenosis were treated by using Le Fort III osteotomy and midfacial DO from August 2000 to February 2007. The 3D reconstruction of the upper-airway from CT data was used to evaluate the upper airway volume before and after the operation. And meanwhile polysomnography was carried out to demonstrate the upper airway functional changes. There was a 64.3% mean increase [mean, (9.13 +/- 6.94) ml, P < 0.05] in upper airway volume in the 11 cases after the operations. It showed that there was significant improvements in the indexes of polysomnography after the operations, such as apnea and hypopnea index, average SaO2, minimum oxygen saturation and snore index. The Le Fort III osteotomy and midfacial distraction osteogenesis can efficiently relieve the symptoms of upper-airway stenosis in severe midfacial dysostosis.

Postoperative nursing of patients underwent Le Fort III osteotomy and medium position distraction

目的 探讨LefortⅢ型截骨中位牵张成骨术患者的术后护理.方法 本研究在我科采用LefortⅢ型截骨及弹性牵引的基础上,改进了系列护理技术,2001-2005年,对治疗严重面中份发育不全的7例患者,加强了术后呼吸道、伤口及牵引等护理与指导.结果 1例患者出现枕部小片脱发,余无一例因护理不当并发症发生.7例患者术后恢复良好,面容有效改善.结论 良好的护理技术可以提高手术成功率,减少并发症。

Fronto-orbital advancement with simultaneous LeFort III-distraction

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.