Midface distraction without osteotomies in an infant with upper respiratory obstruction.
Midface hypoplasia is a common craniofacial anomaly and may manifest as part of a wider syndrome or as an isolated finding. Underlying this condition is a complex morphology, resulting from development across multiple interacting suture systems. Current treatment relies on various combinations of osteotomies and distraction using internal or external devices. Such procedures, while often successful, involve significant morbidity and trauma to the very young patients whom comprise the majority of the treatment group. The present article describes the successful development of a technique for midfacial distraction without osteotomies. In a case study representing a series of 11 patients, a 4-month-old baby girl with midface hypoplasia and respiratory obstruction requiring nasopharyngeal intubation underwent this 2-stage procedure. After 72-day distraction, upper incisor-posterior clinoid process distance had increased 18.4 mm, and by 4 months after removal of the distraction devices, it had increased a further 2.6 mm. Craniofacial morphology was markedly improved combined with complete resolution of her respiratory obstruction. No blood transfusion or intensive care facility was required. This innovation demonstrates a procedure with similar efficacy but significantly reduced morbidity and cost compared with existing methods. Interestingly, continued growth after the distraction period may allude to a different mechanism of induced osteogenesis than previously described.
Graewe
Frank R
FR
Division of Plastic and Reconstructive Surgery, Stellenbosch University, Cape Town, South Africa. graewe@sun.ac.za
Morkel
Jean A
JA
Hartzenberg
Henry B
HB
Ross
Richard J
RJ
Zuehlke
Alexander E
AE
D000402:Airway Obstruction / Q000601:surgery*; D002508:Cephalometry; D003388:Cranial Fossa, Posterior / Q000473:pathology; D019465:Craniofacial Abnormalities / Q000601:surgery*; D005260:Female; D005624:Frontal Bone / Q000002:abnormalities; D006801:Humans; D021621:Imaging, Three-Dimensional; D007180:Incisor / Q000473:pathology; D007223:Infant; D008437:Maxilla / Q000002:abnormalities / Q000473:pathology; D008445:Maxillofacial Development / Q000502:physiology; D009915:Orbit / Q000002:abnormalities; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D010027:Osteotomy; D013100:Sphenoid Bone / Q000473:pathology; D014057:Tomography, X-Ray Computed