A novel use of the rigid external distraction frame: acute on-table distraction with autologous bone grafting

Distraction osteogenesis with an external distraction device such as the rigid external distraction (RED) frame has become an established method for treating midface hypoplasia. It allows for greater advancement of the midface than achievable with traditional Le Fort III osteotomies; however, there are a number of problems associated with frame application such as pin site migration and need for frame removal. We present 2 cases of the novel use of the RED frame, in both a pediatric patient and an adult patient. The RED frame was used to achieve table soft tissue distraction, greater than previously achievable with traditional Le Fort III osteotomy. This was then combined with acute bone grafting, allowing the RED frame to be removed intraoperatively and thereby removing the complications associated with long-term frame application. We believe this to be the first reported use of the RED frame for acute on-table distraction of the midface. This has allowed far greater advancement of the midface than would be achievable with traditional Le Fort III advancement but, when combined with autologous bone grafting, has allowed intraoperative removal of the frame, thus negating some of the complications of long-term distraction osteogenesis using the RED frame.