[Midfacial callus distraction in a patient with Crouzon syndrome]

The treatment of syndromic hypoplasias of the midfacial complex, for example in Crouzon patients, is necessary at an early stage for functional and aesthetic reasons. If midfacial advancement is done by the traditional technique using bone grafts, it has often been seen that the normal occlusion originally achieved changes in an Angle class III, because the mandible grows regularly but not the midface. This problem could probably be solved if midfacial advancement is done by the gradual callus-distraction procedure. The local osteogenesis involves the possibility that there is normal growth of the midfacial complex even if the operation is performed in young children. Based on experience in mandibular bone lengthening, this new method was used in a 10-year-old Crouzon patient. As successful lengthening of the midface needs a stable device and a reliable base, a new midfacial distractor was designed using the principle of the halo-frame. With an advancement of about 22 mm the midfacial position was normalized and a regular overbite was achieved. In a case report the new technique is shown and the results are demonstrated and discussed. Despite this encouraging early result a long-term follow-up is not yet possible.