Guided insertion of transfacial pin for early midface distraction in syndromic craniosynostosis: a retrospective...

Syndromic craniosynostosis presents with premature fusion of multiple calvarial sutures including the skull base. This could result in severe mid-face retrusion, exorbitism, obstructive sleep apnea and elevated intracranial pressure (ICP). Fronto-orbital advancement or posterior calvarial vault distraction is performed early to reduce ICP, while the midface is handled later to ensure stability and reduce the frequency of interventions. Severe airway and ocular complications necessitate early midface advancement preferably using distraction. This study aims to assess outcomes and safety of early midface distraction (EMD) using guided transfacial pin fixation (GTP) in young individuals. A retrospective cohort study was conducted of all transfacial pin fixated midface distraction surgeries performed by a single surgeon between 2014 and 2024. Data reviewed included demographics, attempts required for pin insertion, accuracy of pin insertion, deviation from desired path, magnitude of distraction, functional outcome involving airway, globe position and complications. Fourteen patients underwent transfacial pin fixated midface distraction of which 6 involved use of 3D printed guides. The mean age was 4.3 years. All patients had significant obstructive sleep apnea and exorbitism. C-arm radiography was used as a standard monitoring aid irrespective of the use of guides. Twelve patients had undergone fronto-orbital advancement prior to midface advancement. We encountered minor intra-operative complication involving transfacial pin in 1 patient. Use of 3D printed guide appears to be safe and effective method for insertion of transfacial pins in centers which do not employ robotic assistance.