Internal Le Fort III distraction with biodegradable devices.
Shortly after the initial application of distraction osteogenesis to the human mandible by McCarthy, distraction osteogenesis was used for gradual lengthening of the midface in children with syndromic craniosynostosis, cleft lip and palate, hemifacial microsomia, and midface hypoplasia from other causes. Both external and internal devices are available for midface distraction. In spite of the many advantages of internal metallic distraction devices, they can be more difficult to remove. By substituting the metallic fixation plates of the Stryker-Leibinger Modular Internal Distraction system, with resorbable MacroPore fixation mesh, only the distractor screw and cable drive need to be removed. Moreover, by using a resorbable stabilizer, the screw and cable components are not needed for the consolidation phase, and can be removed at the completion of active distraction. In this case report of a 4-year-old girl with Crouzon's syndrome, contouring of the resorbable distraction devices was performed using a sterilizable model, 20 mm of distraction was achieved, and 4 days later the distractor screw was replaced with a resorbable stabilizer, resulting in an excellent correction of her midface hypoplasia.
Cohen
S R
SR
Craniofacial Surgical Services, Children's Hospital and Health Care Center of San Diego, California, USA. scohen@sdfaces.com
Holmes
R E
RE
D020341:Absorbable Implants; D001860:Bone Plates; D001861:Bone Regeneration; D001863:Bone Screws; D002675:Child, Preschool; D003394:Craniofacial Dysostosis / Q000601:surgery; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008437:Maxilla / Q000601:surgery; D009915:Orbit / Q000601:surgery; D019857:Osteogenesis, Distraction / Q000145:classification / Q000295:instrumentation*; D019340:Osteotomy, Le Fort / Q000145:classification / Q000295:instrumentation*; D013499:Surface Properties; D013526:Surgical Mesh