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In this video, we showcase the bilateral subcranial Le Fort III osteotomies with midface distraction using Kawamoto distractors.
The surgery was performed in a 4-year-old boy with Crouzon Syndrome to correct his severe proptosis, increase the nasopharyngeal airway space and improve his severe negative overjet. Internal distractors were chosen to achieve maximum correction at this age.
The patient undergoing surgery had no intraoperative or postoperative complications. A full separation of his facial bones was achieved. The patient had an uneventful recovery period, and there was a significant improvement in his proptosis and malocclusion.
Santiago Gonzalez, BS, BA (1); Michael Golinko, MD, MS (2)
1. University of Arkansas for Medical Sciences – College of Medicine
4301 W. Markham, #550
Little Rock, AR
72205
2. Vanderbilt University Medical Center, Department of Plastic Surgery
2900 Children’s Way, 9th Floor Doctor’s Office Tower
Nashville TN 37232
The authors have no conflicts of interest to disclose.
1. Shetye P, Giannoutsos E, Grayson B, McCarthy J. Le Fort III Distraction: Part I. Controlling Position and Vectors of the Midface Segment. Plast Reconstr Surg. 2009;124(3):871-878. doi:10.1097/prs.0b013e3181b17b57
2. Diner P. Le Fort III Advancement with Gradual Distraction Using Internal Devices. Plastic & Reconstructive Surgery. 1997;100(Supplement 1):831,832. doi:10.1097/00006534-199709001-00002
3. Mathijssen I. Guideline for Care of Patients With the Diagnoses of Craniosynostosis. Journal of Craniofacial Surgery. 2015;26(6):1735-1807. doi:10.1097/scs.0000000000002016
4. Rapp S, Uribe-Rivera A, Pan B, Billmire D, Gordon C. Outcomes and Analysis When Utilizing a Minimal Incision Lefort III Osteotomy and Rigid External Distraction on Syndromic Patients with Obstructive Sleep Apnea. Plast Reconstr Surg. 2013;132:123. doi:10.1097/01.prs.0000436003.41308.3e
5. Lao W, Denny A. Internal Distraction Osteogenesis to Correct Symptomatic Cephalocranial Disproportion. Plast Reconstr Surg. 2010;126(5):1677-1688. doi:10.1097/prs.0b013e3181ef8f65
6. Polley J, Figueroa A. Management of Severe Maxillary Deficiency in Childhood and Adolescence Through Distraction Osteogenesis With an External, Adjustable, Rigid Distraction Device. Journal of Craniofacial Surgery. 1997;8(3):181-185. doi:10.1097/00001665-199705000-00008
7. Klsmartin: Kawamoto Midface Distractor. Klsmartinnorthamerica.com. http://www.klsmartinnorthamerica.com/products/distraction-devices/lefort-iii-and-monobloc/kawamoto-midface-distractor/. Published 2018. Accessed November 28, 2018.
8. Orra S, Tierney W, Capone A, Gharb B, Papay F, Doumit G. Relevant Surgical Anatomy of Pterygomaxillary Dysjunction in Le Fort III Osteotomy. Plast Reconstr Surg. 2017;139(3):701-709. doi:10.1097/prs.0000000000003084
9. Caterson E, Shetye P, Grayson B, McCarthy J. Surgical Management of Patients with a History of Early Le Fort III Advancement after They Have Attained Skeletal Maturity. Plast Reconstr Surg. 2013;132(4):592e-601e. doi:10.1097/prs.0b013e31829f4b11
10. Hettinger P, Hanson P, Denny A. Le Fort III Distraction Using Rotation Advancement of the Midface in Patients with Cleft Lip and Palate. Plast Reconstr Surg. 2013;132(6):1532-1541. doi:10.1097/prs.0b013e3182a97ebc
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