title: A novel technique to secure the Rigid External Distraction (RED) frame in a thin skull allowing sutural mid-face distraction.
abstract: Distraction osteogenesis (DO) has revolutionised the treatment of mid-face hypoplasia in children, allowing advancement of the mid-face in excess of that achievable by traditional Le Fort III osteotomy. One method of performing DO is to use an externally applied frame, such as the Rigid External Distraction (RED) frame. However, at young ages the cranial bone is often too weak to support the frame, preventing its safe use. We present the case of a patient with Crouzon syndrome who required mid-face distraction at 4-months of age due to severe exorbitism, raised intracranial pressure and airway compromise. In order to allow safe application of an external distraction frame laminated bone grafts were secured to the cranium at the areas of frame pin insertion. We believe this to be the first reported case of the use of the patients own cranial bone to create laminated bone grafts and thicken the site of pin insertion. The method described adds to the armamentarium of the surgeon treating these patients who require placement of an external distraction frame for DO at a young age where the thickness of the cranial bone may otherwise prevent safe application.
authors: Oxford Craniofacial Unit (Head: Mr. Steven Wall), Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom.
authors: Thomas D
authors: TD
authors: Dobbs
authors: Oxford Craniofacial Unit (Head: Mr. Steven Wall), Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom.
authors: Steven A
authors: SA
authors: Wall
authors: Oxford Craniofacial Unit (Head: Mr. Steven Wall), Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom.
authors: Peter G
authors: PG
authors: Richards
authors: Oxford Craniofacial Unit (Head: Mr. Steven Wall), Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom. Electronic address: david.johnson@ouh.nhs.uk.
authors: David
authors: D
authors: Johnson
mesh_terms: D064592:Autografts / Q000637:transplantation; D001858:Bone Nails; D016025:Bone Transplantation / Q000379:methods; D003393:Cranial Sutures / Q000002:abnormalities / Q000601:surgery*; D003394:Craniofacial Dysostosis / Q000601:surgery*; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000002:abnormalities; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007223:Infant; D019586:Intracranial Hypertension / Q000601:surgery; D019857:Osteogenesis, Distraction / Q000295:instrumentation*; D010294:Parietal Bone / Q000002:abnormalities / Q000601:surgery; D013701:Temporal Bone / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Bone grafting; Craniosynostosis; Distraction osteogenesis; Mid-face distraction; Rigid External Distraction frame; Sutural distraction