Frontofacial osteotomies, advancement, and remodeling by distraction: an extended application of the technique

The purpose of this clinical report is to present the distraction technique for advancement of the frontofacial skeleton as a unit. Our 14-year-old patient was diagnosed with Carpenter's syndrome and kleblattschädel deformity at birth. At other centers the patient underwent corrective surgeries, including repeated fronto-orbital advancement in an attempt to correct the residual deformity. This has resulted in bony malunion and recurrent deformity, and it has left the patient with no available donor sites for harvesting of bone graft. The patient had class III malocclusion, severe midfacial and frontal deficiency, and relative turricephaly. We performed frontofacial osteotomies and placement of the distraction devices. Distraction of 20 mm was accomplished, correcting the exophthalmos and midface retrusion and producing class I dental occlusion. We conclude that distraction is an optional surgical method that can be applied in selected cases for advancement of the entire frontofacial skeleton.