title: Frontofacial advancement by distraction osteogenesis: a long-term review.
abstract: BACKGROUND
  Frontofacial advancement by distraction osteogenesis is known to produce significant functional and aesthetic gains in the short and medium term. Little is known about the long-term effects of this technique. The authors present a long-term review of frontofacial advancement by distraction in patients with syndromic craniosynostosis.
  
  
  METHODS
  In 2008, Witherow et al. presented functional outcomes in 20 consecutive patients who underwent frontofacial advancement by distraction osteogenesis using the rigid external distractor frame. This retrospective study has revisited the outcomes in these patients after a mean follow-up period of 10.2 years.
  
  
  RESULTS
  Records for the original 20 patients were assessed. Cephalometric analysis demonstrated stable advancements over the long term. No patient achieved any anterior growth of the midface after frontofacial advancement. Long-term follow-up demonstrated a later deterioration of respiratory function in the younger group of patients (36.4 percent). Four patients required adenotonsillectomy. One patient has a persistent tracheostomy. Only one patient required further procedures to correct recurrent raised intracranial pressure. None of the patients in the older group experienced a deterioration of function. Other procedures included reduction of the supraorbital ridge, bimaxillary osteotomies, and rhinoplasties.
  
  
  CONCLUSIONS
  Frontofacial distraction produced long-term stable advancement in all cases, and 15 of the 17 living patients (88.2 percent) achieved stable functional gains. Anterior growth of the midface does not occur following monobloc distraction. Deterioration in function is seen in those who undergo this procedure at a young age. The authors recommend regular follow-up of these patients.
  
  
  METHODS
  Therapeutic, IV.
authors: London, United Kingdom From the Great Ormond Street Hospital for Children.
authors: Ivo
authors: I
authors: Gwanmesia
authors: Owase
authors: O
authors: Jeelani
authors: Richard
authors: R
authors: Hayward
authors: David
authors: D
authors: Dunaway
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery; D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000150:complications / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000209:etiology / Q000601:surgery; D008297:Male; D019186:Mandibular Advancement; D019857:Osteogenesis, Distraction / Q000523:psychology / Q000706:statistics & numerical data; D013517:Otorhinolaryngologic Surgical Procedures; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011584:Psychology; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000209:etiology / Q000601:surgery
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