Neonatal midface distraction without osteotomies with a transfacial pin- advances towards the development of a safe and reliable procedure

摘要

Background: Over the past decade, midfacial distraction has been validated by numerous publications as an effective procedure for the treatment of syndromic midfacial hypoplasia. LeFort III and Monobloc distractions have been widely described on patients in their secondary dentition, prior to or at the completion of facial growth. In early infancy and childhood, patients with syndromic midfacial hypoplasia such as Crouzon's, Apert's, and Pfeiffer's can present with three significant issues necessitating intervention: 1) craniosynostosis, with its inherent risks of increased intracranial pressure and abnormal growth pattern of the skull, 2) orbital proptosis, with its risks of corneal ulceration and orbital dislocation, and 3) severe obstructive sleep apnea due to midfacial hypoplasia and upper airway obstruction. The treatment of craniosynostosis within the first year of life is well established by many techniques as one of the mainstays of craniofacial surgery. Treatments remain inadequate, however, for the complications related to the severe midfacial hypoplasia. Frontoorbital advancement can partially address the significant proptosis seen in many patients, and tarsorraphies can be performed to help lessen the risk of corneal ulceration. Nasopharyngeal airways, CPAP, and tracheostomies can be used to address the airway issues seen with obstructive apnea. Standard LeFort III or Monobloc advancements in this age group run the risk of significant operative morbidity as well as early relapse, and secondary procedures are hampered by the presence of scarring and bone grafts present from previous interventions. It would seem apparent that early midface distraction could be utilized to address these issues.