title: A low-cost method of craniofacial distraction osteogenesis.
abstract: OBJECTIVE
  Distraction osteogenesis is an effective treatment modality for the correction of craniofacial deformities. The cost of these devices is significant and may preclude routine use of these distractors in developing countries. Hence, distraction osteogenesis was performed using medical equipment that was readily available in any hospital at minimal cost.
  
  
  METHODS
  From 2008 to 2013, a retrospective study was performed on infants and neonates who underwent primary distraction for craniofacial abnormalities. Midface or mandibular distraction was performed because of respiratory impairment and/or globe exposure. The apparatus used included Steinmann pins, stainless steel wires, attachment bolts, orthopaedic pulleys, string and intravenous bags for weights. For midface distraction, a transzygomatic pin was inserted, and a transmandibular pin or a cerclage wire was inserted into the mandible through the symphysis or body of the mandible and connected to the pulley system.
  
  
  RESULTS
  Distraction osteogenesis was performed on five patients - three mandibular distractions (Pierre Robin sequence) and two transfacial distractions (Apert syndrome/Pfeiffer syndrome type III). The mean age, duration of distraction and duration of consolidation at the time of distraction was 60.5 days, 18.6 days and 16.4 days, respectively. The mean length of distraction achieved was 12 mm. Common complications observed were pin loosening, pressure necrosis of the skin and uneven pull. A major disadvantage was the longer hospital stay required.
  
  
  CONCLUSIONS
  The African method of distraction is effective, easy and cost effective and could be used in third-world hospitals where surgical expertise or expensive distraction sets are not freely available.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Road (Bellair Road), Cato Manor, Durban, South Africa. Electronic address: gerritgreyvensteyn@yahoo.com.
authors.forename: Gerhardus A
authors.initials: GA
authors.lastname: Greyvensteyn
authors.affiliation: Department of Plastic and Reconstructive Surgery, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Road (Bellair Road), Cato Manor, Durban, South Africa.
authors.forename: Anil
authors.initials: A
authors.lastname: Madaree
mesh_terms: D000168:Acrocephalosyndactylia / Q000601:surgery; D015331:Cohort Studies; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D019465:Craniofacial Abnormalities / Q000175:diagnosis / Q000191:economics* / Q000601:surgery*; D003906:Developing Countries; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008334:Mandible; D019857:Osteogenesis, Distraction / Q000191:economics* / Q000379:methods*; D010855:Pierre Robin Syndrome / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D013019:South Africa; D016896:Treatment Outcome
keywords: Distraction osteogenesis; Mandibular distraction; Midface distraction; Pfeiffer syndrome; Pierre Robin sequence