Blindness as a complication of monobloc frontofacial advancement with distraction.
The monobloc frontofacial osteotomy provides aesthetic and functional improvement in the treatment of various craniofacial deformities. This procedure, through highly complex, has had some significant associated complication, such as cerebrospinal fluid leakage, hematoma, infection, and bone resorption. Distraction has been successfully used to gradually elongate bone and soft tissue. This method seems to provide improved results over conventional surgery, with less morbidity. We present a case of a patient with Apert syndrome who underwent monobloc advancement using the Rigid External Device (RED) device and who developed a transient bilateral amaurosis on the fourth postoperative day before distraction. A second procedure was performed to push back the frontal bandeau, maintaining the device in position. The blindness was resolved with this procedure as well as treatment with systemic steroids. The distraction was started thereafter, and the desired improvement was acquired. To our knowledge, this is the first case of transient bilateral amaurosis in a patient undergoing monobloc distraction.
Alonso
Nivaldo
N
Division of Plastic Surgery, São Paulo University, São Paulo, Brazil. nivalonso@uol.com.br
Goldenberg
Dov
D
Fonseca
Alexandre S
AS
Kanashiro
Eduardo
E
Matsushita
Hamilton
H
Freitas
Renato da Silva
Rda S
Shin
Joseph H
JH
D000168:Acrocephalosyndactylia / Q000628:therapy*; D001766:Blindness / Q000209:etiology* / Q000628:therapy; D002648:Child; D005147:Facial Bones / Q000002:abnormalities / Q000601:surgery*; D005260:Female; D005624:Frontal Bone / Q000002:abnormalities / Q000601:surgery*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use; D019857:Osteogenesis, Distraction / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods
D005938:Glucocorticoids; D008775:Methylprednisolone