Intracranial migration of halo fixation pins: a complication of using an extraoral distraction device.
OBJECTIVE
Distraction osteogenesis is a well-accepted technique in the treatment of patients with hypoplastic craniofacial components. Complications of distraction osteogenesis are well described in the literature. We describe a complication of using an external distraction device in a 9-year-old girl with Pfeiffer.


RESULTS
A modified Lefort III osteotomy was performed for maxillary hypoplasia with application of an external distraction halo device by a pediatric neurosurgeon. A postoperative computed tomography (CT) scan showed 0.5-cm skull penetration of the cranial pins. The pins were repositioned and the patient was followed up on a regular basis until discharge from the hospital. At 3-week follow-up, a CT scan of the head showed migration of the pins 1.5 cm intracranially. The halo was removed and repositioned at a different site. No detectable neurological sequelae from the pin penetration were noted. The patient developed cellulitis at the site of the penetration and was admitted to the hospital for a course of intravenous antibiotics. There were no other complications, and the rest of her treatment course proceeded as planned. A review of the literature on complications of halo usage as well as suggestions for their management in association with distraction osteogenesis is described.
Le
B T
BT
Department of Oral and Maxillofacial Surgery, University of Southern California-Los Angeles Children's Hospital, Los Angeles, CA, USA.
Eyre
J M
JM
Wehby
M C
MC
Wheatley
M J
MJ
D000168:Acrocephalosyndactylia / Q000150:complications; D001858:Bone Nails / Q000009:adverse effects*; D001921:Brain; D002648:Child; D016267:External Fixators / Q000009:adverse effects; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology*; D006801:Humans; D008437:Maxilla / Q000002:abnormalities / Q000601:surgery*; D008844:Micrognathism / Q000209:etiology / Q000601:surgery; D019647:Oral Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000295:instrumentation*; D019340:Osteotomy, Le Fort