title: [Trans-facial distraction of the facial skull at the LeFort III level].
abstract: BACKGROUND
  Several craniofacial deformities and syndromes feature hypoplasia of the midface skeleton. Until now different treatment options were based primarily on a modified LeFort III osteotomy: (1) the conventional LeFort III osteotomy with bone transplantation and intraoperative osteosynthesis, (2) distraction using subcutaneous distraction devices fixed on both sides at the os zygomaticum, and (3) bone distraction using a rigid external distraction device (RED distractor), which is fixed to the skull and pulling at the maxilla or the upper teeth.
  
  
  RESULTS
  A modification of the distraction technique using the RED distraction device is presented. The tensile forces are applied to the ramus infraorbitalis or the apertura piriformis, and the tensile wires penetrate through the skin laterally to the nose. By using this new approach near the center of rotation or the center of resistance, optimal control of the vector of distraction is guaranteed. With sufficient distraction of the midface, overcorrection of the os zygomaticum can be avoided. Clinical data of seven patients are presented.
  
  
  CONCLUSIONS
  Due to the good clinical results, external transfacial distraction with tensile forces pulling at the apertura piriformis seems to improve the treatment of these complex facial deformities.
authors.affiliation: Klinik und Poliklinik für Zahnärztliche Chirurgie und für Mund-, Kiefer- und Plastische Gesichtschirurgie, Universität Köln, Kerpenerstrasse 62, 50937 Köln. A.Kuebler@uni-koeln.de
authors.forename: A
authors.initials: A
authors.lastname: Kübler
authors.forename: J
authors.initials: J
authors.lastname: Zöller
mesh_terms: D000168:Acrocephalosyndactylia / Q000601:surgery; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003394:Craniofacial Dysostosis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008443:Maxillary Sinus / Q000528:radiation effects; D019767:Maxillofacial Abnormalities / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000379:methods; D010025:Osteoradionecrosis / Q000601:surgery; D019340:Osteotomy, Le Fort / Q000379:methods*