DISTRACTION OSTEOGENESIS AND ITS APPLICATION TO THE MIDFACE AND BONY ORBIT IN CRANIOSYNOSTOSIS SYNDROMES

The purpose of this study was to demonstrate the potential advantages of applying distraction osteogenesis techniques to the correction of o rbital and midfacial hypoplasia in craniosynostosis syndromes. Fifteen children with various craniosynostosis syndromes underwent Le Fort II I advancement assisted by gradual distraction utilizing a pair of inte rnal distraction devices custom-fabricated for each child. The surgica l procedure consisted of a Le Fort III osteotomy, implantation of inte rnal devices with initiation of distraction intraoperatively, and an a ccelerated rate of midfacial advancement over the next 3 to 5 days. Ac tivation of the distraction hardware was accomplished by a percutaneou s pin, which was removed at the end of the distraction protocol, allow ing the internal devices to fixate the fragment for a minimum of 6 mon ths during the period of consolidation. With follow-up ranging between 3 to 38 months, the average orbital and midfacial advancement was 19. 7 mm (range, 12.0-30.0 mm). Proptosis was lessened and facial proporti ons significantly improved in all patients. Serious complications were not encountered. The modified distraction protocol utilized in this g roup of patients was aimed at addressing the unique requirements of pe diatric craniofacial surgery, and resulted in almost twice the amount of correction previously reported for traditional rigid fixation techn iques.