Le Fort II Distraction With Zygomatic Repositioning: A Technique for Differential Correction of Midface Hypoplasia

Hopper, Richard A.; Kapadia, Hitesh; Susarla, Srinivas M.

doi:10.1016/j.joms.2018.04.023

Cited by 21 publications

(19 citation statements)

References 30 publications

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“…The subunit osteotomy principle, especially with regards to use of an independent LeFort II segment, was initially highlighted by Tulasne and Tessier, 19 who used a LeFort II osteotomy with a simultaneous mandibular osteotomy for correction of clockwise rotation deformity in Treacher Collins syndrome. The zygomatic positioning described in our salvage operation bears striking anatomical similarities to those seen in a LeFort II distraction with zygomatic repositioning described by Hopper et al 20,21 The final result in this case demonstrated similar correction of exorbitism in combination with favorable control over sagittal projection of the midface through external distraction. We hope that this case report provides a useful therapeutic option for surgeons experiencing a similar complication in the future.…”

Section: Discussionsupporting

confidence: 76%

Unanticipated Fractures of the Zygomatic-Maxillary Suture in LeFort III Internal Distraction: Salvage of Midfacial Advancement via Rigid External Distraction of an Orphaned LeFort II Segment

Coalson

Roy

Bruce

et al. 2021

FACE

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Currently, the most common approach for treating midface hypoplasia in syndromic craniosynostoses patients is the LeFort III with distraction osteogenesis. Distraction osteogenesis can be performed through either internal or external distraction systems. Each modality offers unique advantages and disadvantages. A rare complication associated with internal distraction is fracture of the zygomatic-maxillary suture caused by distraction forces on this area. This complication has been reported in patients with Pfeiffer and Apert syndromes, related to convexity of temporal bones increasing force on the zygomatic-maxillary suture. In the current report, we present the first case in the literature of an internal distraction associated zygomatic-maxillary fracture in a patient with Crouzon syndrome. We also present a subunit osteotomy salvage approach. Through mobilization of a LeFort II segment and rigid external distraction to advance orphaned segments of the midface, a favorable aesthetic result was salvaged from this complication.

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Section: Discussionsupporting

confidence: 76%

Unanticipated Fractures of the Zygomatic-Maxillary Suture in LeFort III Internal Distraction: Salvage of Midfacial Advancement via Rigid External Distraction of an Orphaned LeFort II Segment

Coalson

Roy

Bruce

et al. 2021

FACE

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“…A segmental Le Fort II osteotomy along with zygoma repositioning to achieve more advancement in the central maxilla, compared to the zygomatic orbital relationship, is also showing benefit. 51,53–56…”

Section: Discussionmentioning

confidence: 99%

Influence of Nonsyndromic Bicoronal Synostosis and Syndromic Influences on Orbit and Periorbital Malformation

Forte

Dinis

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Oculoorbital disproportion in patients with craniosynostosis has similarities and dissimilarities between syndromic and nonsyndromic cases. The authors hypothesized that these two conditions have specific individual influences as they relate to development of the orbital and periorbital skeletons. Methods: A total of 133 preoperative computed tomography scans (nonsyndromic bicoronal synostosis, n = 38; Apert syndrome bicoronal synostosis subtype, n = 33; Crouzon syndrome bicoronal synostosis subtype, n = 10; controls, n = 52) were included. Craniometric and volumetric analyses related to the orbit and periorbital anatomy were performed. Results: Orbital cavity volume was mildly restricted in nonsyndromic bicoronal synostosis (7 percent, p = 0.147), but more so in Apert and Crouzon syndromes [17 percent (p = 0.002) and 21 percent (p = 0.005), respectively]. The sphenoid side angle in Apert syndrome was wider than when compared to Crouzon syndrome (p = 0.043). The ethmoid side angle in Apert patients, however, was narrower (p = 0.066) than that in Crouzon patients. Maxilla anteroposterior length was more restricted in Apert syndrome than Crouzon syndrome (21 percent, p = 0.003) and nonsyndromic cases (26 percent, p < 0.001). The posterior nasal spine position was retruded in Crouzon syndrome (39 percent, p < 0.001), yet the anterior nasal spine position was similar in Apert and Crouzon syndromes. Conclusions: Orbit and periorbital malformation in syndromic craniosynostosis is likely the combined influence of syndromic influences and premature suture fusion. Apert syndrome expanded the anteriorly contoured lateral orbital wall associated with bicoronal synostosis, whereas Crouzon syndrome had more infraorbital rim retrusion, resulting in more severe exorbitism. Apert syndrome developed maxillary hypoplasia, in addition to the maxillary retrusion, observed in Crouzon syndrome and nonsyndromic bicoronal synostosis patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

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“…Although fat grafting can be considered, Apert patients are often very thin as a consequence of obstructive sleep apnea and related efforts to breathe, making graft harvesting difficult. As an alternative to fat grafting, Hopper and collaborators 16 utilized a customized forehead implant simultaneous to Le Fort II and zygomatic repositioning, and kept the patient intubated for 2 days to allow the soft tissue to seal off and decrease communication between the oral and nasal cavities and forehead, in order to reduce the likelihood of implant infection.…”

Section: Discussionmentioning

confidence: 99%

“…15 Subcranial procedures that have lower complication rates when compared with monobloc advancement are Le Fort III and Le Fort II with zygomatic repositioning, and these procedures can also achieve optimal results. [15][16][17] Depending upon the degree of asymmetry (by means of bony irregularities) of the forehead, the performance of specific subcranial procedures may also necessitate additional procedures to improve forehead contour. Although fat grafting can be considered, Apert patients are often very thin as a consequence of obstructive sleep apnea and related efforts to breathe, making graft harvesting difficult.…”

Section: Discussionmentioning

confidence: 99%

Apert Syndrome Outcomes: Comparison of Posterior Vault Distraction Osteogenesis Versus Fronto Orbital Advancement

Raposo-Amaral

Oliveira

Raposo‐Amaral

et al. 2021

Journal of Craniofacial Surgery

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Background: Presenting a wide clinical spectrum and large variety of clinical features, successful treatment of Apert syndrome necessitates performance of sequential multiple surgeries before a patient's facial skeleton growth is complete.The objective of this study is to compare forehead contour asymmetry and clinical outcomes between Apert patients who underwent either fronto-orbital advancement (FOA) or posterior vault distraction osteogenesis (PVDO). Methods: A retrospective study was performed on consecutive patients with Apert syndrome who underwent either FOA or PVDO between 2007 and 2019, and participated in at least 6 months of follow-up care. Forehead contour asymmetry and surgical outcomes for each of the included patients were verified through medical records, clinical photographs, and interviews with the parents of the patients. The need for additional craniofacial procedures based on the surgical outcomes of each patient was graded from I to IV utilizing the Whitaker outcome classification system. Results: Forehead contour asymmetry for all included patients was rated under the Whitaker grading scale as type II (n ¼ 4) 44.4%, type III (n ¼ 2) 22.2%, and type IV (n ¼ 3) 33.3% for FOA, and type I (n ¼ 5) 35.7%, type II (n ¼ 7) 50%, and type III (n ¼ 2) 14.3%, for PVDO (P < 0.05). The average transfused blood volume was 47.77 AE 9.42 mL/kg for patients who underwent FOA, and 22.75 AE 10.31 mL/kg for patients who underwent PVDO (P < 0.05). Conclusions: Patients who underwent PVDO had lower forehead contour asymmetry as per the Whitaker outcome grading scale than patients who underwent FOA.

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Le Fort II Distraction With Zygomatic Repositioning: A Technique for Differential Correction of Midface Hypoplasia

Cited by 21 publications

References 30 publications

Unanticipated Fractures of the Zygomatic-Maxillary Suture in LeFort III Internal Distraction: Salvage of Midfacial Advancement via Rigid External Distraction of an Orphaned LeFort II Segment

Unanticipated Fractures of the Zygomatic-Maxillary Suture in LeFort III Internal Distraction: Salvage of Midfacial Advancement via Rigid External Distraction of an Orphaned LeFort II Segment

Influence of Nonsyndromic Bicoronal Synostosis and Syndromic Influences on Orbit and Periorbital Malformation

Apert Syndrome Outcomes: Comparison of Posterior Vault Distraction Osteogenesis Versus Fronto Orbital Advancement

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