Management of Middle Third Hypoplasia Using Rigid External Device: Long-Term Analysis of Results and Report of...

The objective of this study was to review and present the experience, with the functional results as well as complications of the individuals who underwent facial middle-third advancement with rigid external device. We report a major complication (cerebral abscess) secondary to pin migration.

There are functional and esthetics objectives when performing surgical procedures in middle facial third hypoplasia. Many have compared external and internal distraction devices use and results with a lack of evidence on perioperative morbidity; this study was designed to revise complications associated with external distraction.

This retrospective study was conducted over a 5-year period, including 24 patients. Patient's characteristics, perioperative factors, and postoperative complications were revised.

Twenty-four patients undergoing midfacial/fronto-orbital surgery, between 2020 and 2024 were included (Crouzon, Apert, and Kabuki syndromes, cleft lip and palate sequelae, and craniosynostosis cases). The mean follow-up was 39.5 months (±15.98 mo). Monobloc advancement was the most frequently performed procedure (45.8%), followed by Lefort-III (37.5%), Lefort-II (12.5%), and fronto-orbital advancement (8.3%). The mean advancement achieved was 18.9 mm (±6.06 mm). Of the total, 58.33% had no complications, with 37.5% and 4.16% having grade II and grade III-B complications (Clavien-Dindo System). The patient from the case report, had a cerebral abscess, whose course required the removal of the external device, getting a 6.7 mm advancement.

Distraction osteogenesis remains a great procedure where significant midfacial advancement is required, despite the complication rate. There should be a well-defined preoperative and postoperative protocol to avoid major complications from happening.