Kaneshige Satoh1* and Nobuyuki Mitsukawa2
1Department of Plastic and Aesthetic Surgery, Kawasaki Saiwai Hospital, Japan
2Department of Plastic and Reconstructive Surgery, Chiba University, Japan
Objective: Le Fort III distraction or mono bloc fronto-facial distraction has been widely applied for the midfacial recession in syndromic craniosynostosis patients. Conversely considering the degree of upper and lower half of the midfacial recession, dual midfacial distraction of Le Fort III minus I and Le Fort I advancement in Syndromic craniosynostosisis a useful procedure to reduce morbidity of adolescence and adult patients. Here the authors describe the application of extension to younger patients, exhibiting several case reports.Method: 14 cases of Crouzon disease and 4 Apert syndrome are included in this series. Age ranges 10 to 32 years of age. In three cases with severe maxilla-mandibular discrepancy, mandibular setback surgery with sagittal splitting osteotomy was associated with. 4 cases of 10-12 years of age, 4 cases of 13-16 years of age, and 6 cases of 17-32 years of age have been distributed. In all cases, after the Le Fort III osteotomy, Le Fort I osteotomy is added. In the upper portion of Le Fort III minus I, the internal device was used, and in the lower half of Le Fort I segment, bone borne distraction using soft wire connected to Halo device is used. Distraction has been completed from 3-5 days after the surgery to the end of gradual distraction of 1 mm per day.
Result: The amount of distraction was noticed in 15-20 mm in the upper half of the midface and in 12-18 mm in the lower half of midface. No particular complications were noticed including tooth germ injury at the osteotomy and in the distraction phase. Halo device was able to be removed in around 3-4 weeks.Conclusion: Dual midfacial distraction of Le Fort III minus I and Le Fort I is an ideal technique to apply midfacial recession in syndromic craniosynostosis. This report verified the application to younger ages of 10 to 12 years of aged patients.
Syndromic craniosynostosis; Dual midfacial distraction; Maxilla-mandibular discrepancy
Satoh K, Mitsukawa N. Dual Midfacial Distraction of Le Fort III minus I and Le Fort I Advancement in Syndromic Craniosynostosis: Extension of application to Younger Ages. Clin Surg. 2017; 2: 1328.