Document Detail


Achieving differential facial changes with Le Fort III distraction osteogenesis: the use of nasal passenger grafts, cerclage hinges, and segmental movements.
MedLine Citation:
PMID:  22878478     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In traditional Le Fort III distraction, the transport segment is advanced en bloc without addressing differences in the relative retrusion of the facial structure. The authors describe three methods for correcting these asymmetries with differential facial advancement.
METHODS: Eight patients (age range, 4 to 20 years) with asymmetric facial hypoplasia were treated by Le Fort III midface distraction using an external device. 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 nasomaxillary retrusion exceeding zygomatic retrusion underwent segmental Le Fort III osteotomy with simultaneous zygoma repositioning and Le Fort II distraction.
RESULTS: Differential midface advancement was achieved in all patients. Midface distraction and nasal passenger grafts resolved obstructive sleep apnea, improved globe protection, and improved fit of prescription glasses. After Le Fort III swing advancement, the centric relation and malar asymmetry were corrected with differential advances of 10 and 15 mm compared with the unaffected side. In the segmental osteotomy Le Fort III group, the central face was distracted independently of the zygoma repositioning, thus correcting the shortened retruded central midface without distorting the orbitomalar relationship and improving airway obstruction, anterior open bite, short nose, and proptosis.
CONCLUSIONS: 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 aesthetic and functional result.
Authors:
Richard A Hopper; Roni B Prucz; Seree Iamphongsai
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  130     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-30     Completed Date:  2013-01-28     Revised Date:  2014-10-13    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1281-8     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Bone Wires
Child
Child, Preschool
Craniofacial Abnormalities / complications,  surgery*
External Fixators
Facial Asymmetry / congenital,  surgery*
Female
Follow-Up Studies
Humans
Male
Nose / abnormalities*,  surgery
Osteogenesis, Distraction / instrumentation,  methods*
Osteotomy, Le Fort / methods*
Rhinoplasty / methods*
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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