Document Detail

Achieving differential facial changes with Lefort III distraction osteogenesis: the use of nasal passenger grafts, cerclage hinges, and zygomatic repositioning.
MedLine Citation:
PMID:  22878478     Owner:  NLM     Status:  Publisher    
BACKGROUND:: In traditional Lefort III distraction the transport segment is advanced en bloc without addressing differences in the relative retrusion of the facial structure. The purpose of this paper is to describe three methods for correcting these asymmetries with differential facial advancement. METHODS:: Eight patients with asymmetric facial hypoplasia were treated by Lefort III midface distraction using an external device. Ages at surgery ranged from 4-20 years old. Two patients with nasal bone hypoplasia exceeding midface retrusion were treated with nasal passenger grafts at the time of osteotomy. Two patients with asymmetric rotational midface deformities underwent wire cerclage swing advancement of the affected side to achieve differential advancement. Four patients with central naso-maxillary retrusion exceeding zygomatic retrusion underwent segmental Lefort III osteotomy with simultaneous zygoma repositioning and Lefort II distraction. RESULTS:: Differential midface advancement was achieved in all patients. Patients treated with midface distraction and nasal passenger grafts had resolution of obstructive sleep apnea, improved globe protection, and improved fit of prescription glasses. Following Lefort III swing advancement, the centric relation and malar asymmetry were corrected with differential advances of 10 and 15 mm compared to the unaffected side. In the segmental osteotomy Lefort III group, the central face was distracted independent of the zygoma repositioning, thus correcting the shortened retruded central midface without distorting orbito-malar relationship. These patients had improvement in their airway obstruction, anterior open bite, short nose, and proptosis. CONCLUSION:: Midface distraction techniques have evolved to include the principles of segmentation, graft augmentation, and controlled rotation. The benefits of gradual distraction can be realized without compromising the esthetic and functional result. LEVELS OF EVIDENCE:: Clinical Question (Therapeutic Category): Can asymmetric differences in the relative retrusion of the facial structure be corrected with standard distraction techniques?Level of Evidence: IV (case series with pre/post test or only post test).
Richard A Hopper; Roni B Prucz; Seree Iamphongsai
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-8
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  -     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the Craniofacial Center and Division of Plastic Surgery, Seattle Children's Hospital, Seattle, Washington.
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