Digital Planning and Patient-Specific Implants Facilitate Accurate Conventional Sub-Cranial Le Fort III Advancement

Syndromic craniosynostosis is characterized by multisuture fusion, midface hypoplasia, and, frequently, extracranial anomalies. In these patients, transcranial monobloc/facial bipartition or subcranial Le Fort III osteotomy is typically used to achieve total midface advancement. Presented here is a case of conventional subcranial Le Fort III osteotomy in a 15-year-old patient with Apert syndrome using digital planning and patient-specific implants. The accuracy of this procedure was assessed by digitally overlaying the postoperative computed tomography scan onto the preoperative surgical plan. Linear measurements were recorded between the bilateral temporozygomatic and frontozygomatic regions, the most anterior point of the infraorbital rim, and the frontonasal junction. An accurate measurement was defined as any value less than 2 mm. All postoperative landmarks were within 2 mm of the planned position. The greatest deviation occurred in the sagittal plane, averaging 1.17 mm. To the author's knowledge, this is the first report demonstrating the accuracy of digital planning and patient-specific implant-guided correction in conventional subcranial Le Fort III advancement.