Relapse following frontofacial advancement using the rigid external distractor

Area of Science:

• Craniofacial Surgery
• Orthognathic Surgery
• Pediatric Plastic Surgery

Background:

• Multisutural synostosis can cause frontofacial hypoplasia, impacting aesthetics and function.
• Frontofacial advancement via monobloc or bipartition osteotomy can correct these issues.
• Distraction osteogenesis offers larger, safer advancements than conventional osteotomy but raises stability concerns.

Purpose of the Study:

• To evaluate the stability of frontofacial advancement using distraction osteogenesis with a rigid external distractor system.
• To compare the outcomes of two distraction protocols in patients with craniofacial dysostosis.

Main Methods:

• Retrospective study of 21 patients with craniofacial dysostosis.
• Frontofacial advancement using a rigid external distractor system.
• Two distraction protocols: Protocol 1 (24h latency, 1.5 mm/d) and Protocol 2 (7d latency, 1 mm/d).
• Measurements of frontofacial advancement using lateral cephalograms and 3D CT scans.

Main Results:

• Average midface distraction of 16.4 mm (range 12-22 mm).
• Relapse occurred in only 3 of 21 patients, all treated with Protocol 1.
• Protocol 2 (longer latency, slower rate) demonstrated greater stability.

Conclusions:

• Distraction osteogenesis with a rigid external distractor is generally stable for frontofacial advancement.
• A longer latency period and reduced distraction rate enhance stability.
• Overdistraction is not necessary to account for potential relapse in growing infants.