"Piggyback" osteotomies in craniomaxillofacial surgery

The total correction of severe skeletal dysplasias in patients with craniofacial anomalies can often be limited by the use of standard osteotomy designs. In this report, we emphasize the concept of the "piggyback" osteotomy for the correction of severe skeletal dysplasias. The piggyback approach, which uses the tiering or stacking of one osteotomy segment on another, allows the reconstructive surgical team to address multiple skeletal problems in one operative setting adequately. The use of this approach throughout the entire craniomaxillofacial skeleton is illustrated with several clinical examples. The conceptual importance of the piggyback principal and the rationale behind its application are discussed.