Halo distraction of the Le Fort III in syndromic craniosynostosis: a long-term assessment.
BACKGROUND
Little is known about long-term outcomes after Le Fort III halo distraction, such as indications for distraction, amount of relapse, and long-term maxillary growth.


METHODS
During a 5-year period, 51 Le Fort III osteotomies were performed; 41 of these were by halo distraction for the treatment of craniofacial dysostosis (Apert syndrome, 25; Crouzon syndrome, nine; Pfeiffer syndrome, four; other, three). Patient records were reviewed and 104 cephalograms were analyzed.


RESULTS
The average treatment age was 8 years, and the average hospitalization was 5.3 days (3.6 days for the second half of this series). The average distraction was 26 mm (range, 14 to 44 mm), the sella-nasion-subspinale angle increased from 70 degrees to 87 degrees, the upper incisal edge advanced 18 mm, and the vertical distance between nasion and point A increased by 7 mm. There was no maxillary relapse at 1 year and no measurable forward maxillary growth for up to 5 years, although the maxilla did grow vertically (p < or = 0.001). Three patients underwent tracheostomy removal; sleep studies showed the average respiratory disturbance index improved from 24 to 11 (p = 0.004) and the minimum oxygen saturation increased from 81 to 89 (p = 0.006). Three early patients had incomplete advancements.


CONCLUSIONS
The maxilla remained stable after Le Fort III halo distraction without any relapse, and no anterior growth was observed up to 5 years postoperatively. This procedure effectively eliminated sleep apnea in most children, and had a low overall complication rate that declined with experience. Most distracted patients will likely avoid the traditional second Le Fort III.
Fearon
Jeffrey A
JA
Craniofacial Center, North Texas Hospital for Children, Medical City Dallas Hospital, Dallas, Texas, USA. cranio700@aol.com
D000168:Acrocephalosyndactylia / Q000601:surgery; D000293:Adolescent; D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D003394:Craniofacial Dysostosis / Q000150:complications / Q000601:surgery*; D006801:Humans; D008409:Mastication; D019340:Osteotomy, Le Fort / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000209:etiology; D013060:Speech; D016896:Treatment Outcome