MIDFACIAL ADVANCEMENT BY BONE DISTRACTION FOR TREATMENT OF CRANIOFACIAL DEFORMITIES

Craniofaciostenosis is often associated with midfacial hypoplasia and has been treated traditionally using Le Fort advancement osteotomies a nd bone grafts. The surgical procedure requires a prolonged operating time, several osteotomies with a significant blood loss, and wide surg ical exposure. According to the principles of bone lengthening, we per formed midfacial advancement by bone distraction in 4 patients with mi dfacial hypoplasia to reduce the operative time and complication rate. In 2 patients with Crouzon's syndrome we performed a Le Fort III oste otomy and placed the distraction device behind the malar eminence and screwed it on the temporal bone bilaterally. In the other 2 children, with Apert's syndrome, we performed frontal advancement and remodeling before placing the device during the same surgery behind the malar bo ne without any midfacial osteotomy. It appears to us that patients wit h more severe deformities will need surgical procedures to offer more satisfactory results. In these patients, distraction is an initial the rapy to reduce the severity of the deformity, making it possible to ef fect a better treatment afterward.