Fifteen years of experience with the midfacial distraction without maxillary osteotomy protocol

Coeugniet, E; Pellerin, P.; Wolber, Alexis; Dhellemmes, P; Vinchon, Matthieu

doi:10.1007/s00381-013-2323-1

Cited by 4 publications

(6 citation statements)

References 13 publications

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“…The technique is easy and fast, and employs very basic, external hardware with low complication rates. 71 Using transfacial pins for midface distraction in very young patients with midface retrusion and distortion is challenging with a high morbidity rate due to iatrogenic orbital and tooth bud injury 27,70,72 and technical failure, due to their deformed skull and hypoplastic midface. Lack of maxillary growth and an abnormal remodeling pattern results in small-sized bone structure and disorganized architecture in syndromic craniosynostosis (e.g., small zygoma and maxilla, and a high, arched palate).…”

Section: Rationale For the Choice Of Technique And Utility Of Roboticsmentioning

confidence: 99%

“…73 The age profile of our patients with midface distraction is much younger than that reported in other series. 22,[36][37][38][39]70 Compared with traditional osteotomy techniques, the technique of using transfacial pins 27,70 allowed us to ad-dress midface distraction considerably early, when the maxillary-zygomatic junction is relatively fragile, and with reduced blood loss. 70 Although previous authors have used either a freehand technique 70 or navigation to perform the same, 71 robotic assistance allowed the safe passage of the pin in a predetermined trajectory with respect to the globe and tooth buds (Fig.…”

Section: Rationale For the Choice Of Technique And Utility Of Roboticsmentioning

confidence: 99%

“…We present a series of patients with syndromic craniofacial dysostosis with significant airway compromise, OSA, and ocular crisis, who were treated by robot-assisted midface distraction (RAMD) using transfacial pins 27 without FOAR or with FOAR (i.e., robot-assisted frontofacial advancement [RAFFA]). There is no dedicated literature similar to our application of robotic assistance in the craniofacial literature other than our previous work on broader applications of robotics in cranial neurosurgery.…”

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Robot-assisted frontofacial correction in very young children with craniofacial dysostosis syndromes: a technical note and early functional outcome

Udayakumaran

Krishnadas

Subash

2022

Neurosurgical Focus

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OBJECTIVE In this study, the authors aimed to 1) retrospectively analyze the early functional outcomes in a cohort of very young children with craniofacial dysostoses who underwent robot-assisted frontofacial advancement (RAFFA) or robot-assisted midface distraction (RAMD), and 2) analyze the utility of robotic assistance in improving the accuracy and safety of performing transfacial pin insertion for RAFFA or RAMD. METHODS A retrospective analysis of a cohort of 18 children (age range 1–42 months at presentation), who underwent RAFFA or RAMD from February 2015 to February 2021 in the craniofacial unit at Amrita Institute of Medical Sciences and Research Centre in Kochi, India, was performed. Inclusion criteria were patients who had undergone RAFFA in a single stage or RAMD where the cranial vault had been addressed earlier, had been addressed on follow-up, or had not been addressed and had follow-up of at least 6 months. RESULTS Overall, 18 children with syndromic craniosynostosis underwent LeFort level III midface distraction, with or without RAFFA, from February 2015 to February 2021 at a single center in India. The patients’ ages ranged from 6 to 47 months at the time of the procedure. All patients had significant obstructive sleep apnea (OSA), significant ocular issues, and disturbed sleep as determined by the authors’ preoperative protocol. Clinically significant intracranial pressure issues were present in 17 patients. None of the patients had injury due to the transfacial pin trajectory such as globe injury, damage to the tooth buds, or the loss of purchase during the active distraction phase. The mean distraction achieved was 23 mm (range 18–30 mm) (n = 16/18). Of the 18 patients, 10 (56%) had an excellent outcome and 6 (33%) had a satisfactory outcome. In all cases, the degree of OSA had significantly reduced after surgery. Eye closure improved in all patients, and complete closure was seen in 11 patients. On follow-up, the functional gain remained in 14 of 16 patients at the final follow-up visit. The distraction results were stable during the follow-up period (mean 36 months [range 6–72 months]). CONCLUSIONS The early RAFFA and RAMD protocols investigated in this study gave a significant functional advantage in very young patients with craniofacial dysostoses. The results have demonstrated the accuracy and safety of robotic assistance in performing transfacial pin insertion for RAFFA or RAMD.

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Section: Rationale For the Choice Of Technique And Utility Of Roboticsmentioning

confidence: 99%

Section: Rationale For the Choice Of Technique And Utility Of Roboticsmentioning

confidence: 99%

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confidence: 99%

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Robot-assisted frontofacial correction in very young children with craniofacial dysostosis syndromes: a technical note and early functional outcome

Udayakumaran

Krishnadas

Subash

2022

Neurosurgical Focus

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“…The timeframe of development of sinusitis and mucoceles is highly variable. For example, Coeugniet et al 17 reported the development of maxillary sinusitis in one patient with Crouzon syndrome and one with Apert syndrome within seven days of craniofacial surgery. Tatla et al 19 , reported on a 12-year-old boy with Crouzon syndrome that developed frontoethmoidal mucoceles 18-months post-surgery.…”

Section: Sinusitis As a Post-operative Complicationmentioning

confidence: 99%

Recurrent ethmoid mucocele with cellulitis in a patient with Pfeiffer syndrome

Nibber

Honeyman²

2020

JNDS

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Pfeiffer syndrome is one of six craniosynostosis syndromes and presents with craniosynostosis (the premature fusion of one or more calvarial sutures) and skeletal abnormalities. The aetiology of Pfeiffer syndrome is thought to be caused by mutations in the fibroblast growth factor genes FGFR1 and FGFR2. The anatomical complexity of craniosynostosis syndromes means that the long-term management of patients requires a multidisciplinary team approach. Patients with craniosynostosis syndromes are predisposed to sinus infections, including sinusitis, due to structural abnormalities and iatrogenic alterations in sinus anatomy following reconstruction. In this case report, we report a 14-year-old boy with Pfeiffer syndrome who presented with periorbital cellulitis secondary to recurrent ethmoid sinusitis. To the best of our knowledge, this is the first case of ethmoid sinusitis in a patient with Pfeiffer syndrome reported in the literature.

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“…Furthermore, the use of an external device avoids the risk of infection related to intra-focal devices. [52][53][54][55]56].…”

Section: International Archives Of Medicinementioning

confidence: 99%

Apert Syndrome: New treatment and a perspective for the future

Leite¹,

Filgueiras²,

Damasceno³

et al. 2015

Int Arch Med

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Fifteen years of experience with the midfacial distraction without maxillary osteotomy protocol

Abstract: Compared to other techniques, this method is safe, simple and efficient. By sparing major osteotomies, it avoids severe complications.

Cited by 4 publications

References 13 publications

Robot-assisted frontofacial correction in very young children with craniofacial dysostosis syndromes: a technical note and early functional outcome

Robot-assisted frontofacial correction in very young children with craniofacial dysostosis syndromes: a technical note and early functional outcome

Recurrent ethmoid mucocele with cellulitis in a patient with Pfeiffer syndrome

Apert Syndrome: New treatment and a perspective for the future

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