title: Blindness as a complication of monobloc frontofacial advancement with distraction.
abstract: 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.
authors.affiliation: Division of Plastic Surgery, São Paulo University, São Paulo, Brazil. nivalonso@uol.com.br
authors.forename: Nivaldo
authors.initials: N
authors.lastname: Alonso
authors.forename: Dov
authors.initials: D
authors.lastname: Goldenberg
authors.forename: Alexandre S
authors.initials: AS
authors.lastname: Fonseca
authors.forename: Eduardo
authors.initials: E
authors.lastname: Kanashiro
authors.forename: Hamilton
authors.initials: H
authors.lastname: Matsushita
authors.forename: Renato da Silva
authors.initials: Rda S
authors.lastname: Freitas
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Shin
mesh_terms: 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
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone