Le Fort III Distraction Osteogenesis Without Bicoronal Incision
Yoshiaki Sakamoto1, Ikkei Tamada2, Teruo Sakamoto3
1Department of Plastic and Reconstructive Surgery, Keio University School of Medicine.
The Journal of Craniofacial Surgery
|May 31, 2020
Summary
A new Le Fort III distraction osteogenesis technique avoids bicoronal incisions, reducing operative time and blood loss for syndromic craniosynostosis. Careful execution is vital to prevent complications like blindness.
Area of Science:
- Craniofacial Surgery
- Orthognathic Surgery
- Pediatric Plastic Surgery
Background:
- Midfacial hypoplasia in syndromic craniosynostosis often requires Le Fort III distraction osteogenesis.
- Conventional Le Fort III osteotomy typically involves a bicoronal incision.
Purpose of the Study:
- To present a modified Le Fort III osteotomy technique using internal devices without a bicoronal incision.
- To evaluate the safety and efficacy of this novel approach.
Main Methods:
- The Le Fort III distraction technique was performed on 22 patients.
- 17 patients had the conventional bicoronal incision approach.
- 5 patients underwent a new approach using McCord, brow, and gingivo-buccal sulcus incisions.
Main Results:
- The no-coronal-incision group showed reduced mean operative time (357 vs. 410 minutes) and blood loss (33.9 vs. 51.3 ml/kg).
- Patient ages ranged from 6 to 38 years.
- One patient experienced vision loss, highlighting a potential risk.
Conclusions:
- A direct facial approach for Le Fort III distraction offers benefits in reduced operative time and blood loss.
- Incomplete osteotomy or inadequate orbital dissection can lead to blindness.
- This technique necessitates meticulous surgical technique and careful attention to orbital anatomy.
