Frontofacial Monobloc Advancement With Internal Distraction: Surgical Technique and Osteotomy Guide

Abstract

BACKGROUND: Craniosynostosis are cranial deformities resulting from the early closure of 1 or more sutures. Concomitant facial changes are complex and usually result from the involvement of multiple sutures, which may lead to restriction of cranial growth and brain expansion, ocular compression, and breathing difficulties. Surgical techniques to correct syndromic craniosynostosis have improved over time, considerably reducing the rate of complications of this procedure. OBJECTIVE: To describe in detail (step-by-step) and with pertinent anatomic considerations the technique of monobloc frontofacial advancement using internal distractors. METHODS: We describe the monobloc frontofacial advancement technique with the use of internal distractors, which we use in patients with primary syndromic craniosynostosis (Apert, Crouzon, and Pfeiffer) who have major facial hypoplasia and secondary respiratory repercussions. To illustrate this technique, the procedure was performed in 2 cranial models: an adult artificial acrylic skull of normal morphology for better evidence of anatomic repairs and a 3-dimensional printed infant skull from a tomography file obtained from a child diagnosed with Apert syndrome. RESULTS: The benefits of osteogenic distraction and better surgical timing for each procedure are presented. We presented the changes and details of osteotomies performed during the procedure, as well as anatomic details and care regarding the pterygomaxillary dysjunction. CONCLUSION: Monobloc frontofacial distraction is a procedure with widely demonstrated aesthetic and functional results, and this detailed step-by-step description may improve familiarity with the anatomic landmarks of the procedure and provide a better dynamic understanding of the distraction process.

Twenty Year review for Craniofacial Distraction in syndromic craniosynostosis

“…The intraoperative hemorrhage related to craniofacial facial and FFMA poses a life threatening for patients, especially children. The risk of bleeding is associated to venous sinuses, venous hypertension due to raised intracranial pressure and also osteotomies of the pterygopalatine fossa (27). Blood transfusion is considered essential, and we believe it to be a safe practice.…”

Isolated hypertelorism: Late surgical correction using the box osteotomy technique

“…There are several techniques described in the literature: orbital box osteotomy, monobloc frontofacial advancement by distraction, frontofacial bipartition advancement by distraction, and facial bipartition. [ 1 , 4 , 5 ] Nonetheless, the most common are box osteotomy and facial bipartition. [ 8 , 9 , 13 , 14 , 17 ]…”

Síndrome de Apert: Reporte de caso

“…En un estudio retrospectivo en donde se realizó osteogénesis por distracción de la bóveda posterior (PVDO) y avance frontoorbitario (FOA) se logró observar una respuesta terapéutica más favorable en pacientes sometidos a FOA debido a que existía una menor cantidad de complicaciones como sangrado, a la vez que su recuperación era más rápida que en la PVDO (30) . No obstante, Tancreado et al (31) , propone realizar distracción fronto facial en monobloque, el cual además de presentar beneficios en el neurodesarrollo, a su vez obtiene un mejor rasgo estético.…”

“…Además, al ser pacientes con una vía aérea difícil, Tancreado et al (31) , agrega que al existir múltiples complicaciones operatorias y postoperatorias son pacientes con porcentaje elevado en la morbimortalidad, unas de las complicaciones más comunes es la hiponatremia y las convulsiones. Así mismo Isin G (34) .…”