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Skeletal changes after midface surgery in patients with craniofacial deformities: a three-dimensional quantification

P Rostamzad1, T Abdel-Alim2, K El Ghoul3

  • 1Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.

International Journal of Oral and Maxillofacial Surgery
|April 9, 2024
PubMed
Summary

Midface advancement surgery in syndromic craniosynostosis patients shows greater skeletal changes when performed at younger ages. Le Fort III, monobloc, and facial bipartition techniques all resulted in antero-inferior rotation.

Keywords:
Apert syndromeCraniosynostosisCrouzon syndromeHypertelorismLe Fort osteotomyThree-dimensional imaging

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Area of Science:

  • Craniofacial Surgery
  • Pediatric Plastic Surgery
  • 3D Imaging in Medicine

Background:

  • Syndromic craniosynostosis often requires complex midface reconstruction.
  • Le Fort III, monobloc, and facial bipartition are surgical techniques used to correct midface hypoplasia.
  • Understanding skeletal changes post-surgery is crucial for optimizing treatment outcomes.

Purpose of the Study:

  • To evaluate and compare skeletal changes following Le Fort III, monobloc, and facial bipartition surgeries in patients with syndromic craniosynostosis.
  • To investigate the influence of patient age at the time of surgery on the degree of skeletal advancement.

Main Methods:

  • Retrospective analysis of 75 patients with syndromic craniosynostosis (Apert, Crouzon, craniofrontonasal syndrome).
  • Three-dimensional (3D) mesh analysis comparing pre-operative and post-operative scans to quantify skeletal advancement.
  • Surgical techniques included Le Fort III (LFIII), monobloc (MB), and facial bipartition (FB).

Main Results:

  • Le Fort III surgery at ages 7-12 years yielded greater maxillary and zygomatic advancement compared to older patients.
  • Monobloc surgery showed maximal fronto-orbital advancement in patients younger than 7 years.
  • Facial bipartition surgery significantly reduced inter-dacryon distance; all techniques resulted in antero-inferior rotational movement.

Conclusions:

  • Younger age at the time of midface surgery is associated with greater skeletal advancement in syndromic craniosynostosis.
  • Surgical technique and age influence the pattern and extent of skeletal changes.
  • 3D analysis provides valuable insights into the complex skeletal dynamics following craniofacial reconstruction.