Craniofacial distraction with a modular interval distraction system: Evolution of design and surgical techniques

The present report summarizes the evolution of design for a modular interna l distraction system that is applicable throughout the craniofacial region. Eleven patients (5 boys, 6 girls),whose ages ranged from 4 months to 10 ye ars at the time of distraction, constitute the basis for this study. Toe cl inical indications for distraction were exorbitism with corneal exposure (n = 1), obstructive sleep apnea (n = 4). tracheostomy decannulation (n = 1), severe maxillary hypoplasia with class III malocclusion (n = 3), severe ve rtical and sagittal maxillary; deficiency with anophthalmia (n = 1), and re lapse following frontoorbital advancement in a case of rare craniofacial cl efting (n = 1). Twenty two distraction devices were used in these 11 patien ts. Two initial prototypes were tested (prototype 1 = 8 devices; prototype 2 = 2 devices) until the modular internal distraction system (MIDS, Howmedi ca-Leibinger, Inc.) was developed (n = 12 devices). The craniofacial osteot omies used were Le Fort III (n = 4), monobloc (n = 3), mandibular (n = 3), Le Fort I (n = 2), and cranial (n = 1). The distraction distances ranged fr om 11 to 28 mm. One patient undergoing mandibular distraction developed tra nsient swelling in the left mandibular region, which responded to antibioti cs. There were no other complications. Depending on the age of the patient and the length of distraction, the distraction gap was allowed to consolida te from 6 weeks to 3 months. The devices were then removed on either an out patient or a 23-hour-stay basis. The modular internal distraction system pe rmits widespread application of easily customizable, buried distraction dev ices throughout the craniofacial region.