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5 YEAR FOLLOW-UP OF MIDFACE DISTRACTION IN GROWING CHILDREN WITH SYNDROMIC CRANIOSYNOSTOSIS
2:30 pm - 2:40 pm
Presenter: Parit Patel, MD, Loyola University Chicago

Authors: Parit Patel (1), Pradip Shetye (2), Stephen Warren (3), Barry Grayson (4), Joseph G McCarthy (5)

Institutions:
(1) Loyola University, Maywood, IL, (2) New York University Institute of Reconstructive Plastic Surgery, New York, NY, (3) New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, N/A, (4) New York University, New York, NY, (5) New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, NY
First Author:
Parit Patel, MD
Loyola University
Background/Purpose:
Maxillary skeletal position in patients with syndromic craniosynostosis after midface distraction has been shown to be stable 1 year postoperatively. The purpose of this study is to assess midfacial position in the growing child with craniosynostosis 5 years after Le Fort III advancement with a rigid external device (RED).
Methods/Description:
Seventeen patients were identified to have the diagnosis of syndromic craniosynostosis and who underwent a Le Fort III osteotomy with midface advancement. There were 10 males and 7 females, 7 patients had Crouzon syndrome, 5 had Apert syndrome, and 5 had Pfeiffer syndrome. A standard subcranial Le Fort III osteotomy was performed and the midface advanced using forces at the occlusal splint and the zygomatic/maxillary anchor screws. Cephalometric analysis was performed to assess the position of the maxilla over time.
Results:
Immediately after device removal, orbitale advanced 13.67 mm along the x axis and downward 1.70 mm along the y axis. Point A advanced 15.97 mm along the x axis and downward 1.14 mm along the y axis. The greatest average movement was at the level of the upper incisal edge, 16.5 mm along the x axis and downward 1.94 mm along the y axis. At 1 year post-distraction, both orbitale and point A had advanced an additional 0.47 mm and 0.24 mm along the x axis and downward 0.58 mm and 1.78 mm along the y axis respectively. The upper incisal edge moved posterior 0.60 mm along the x axis and downward 3.46 mm along the y axis. At 5 years post-distraction, orbitale moved posterior 0.58 mm, point A advanced an additional 2.08 mm and the upper incisal point advanced 1.93 mm along the x axis. Orbitale, point A and upper incisal point moved downward 3.23, 5.20, and 6.35 along the y axis respectively. We also found that the maxillary and mandibular skeletal discrepancy improved over the 5 year period.
Conclusions:
Immediately after device removal, orbitale advanced 13.67 mm along the x axis and downward 1.70 mm along the y axis. Point A advanced 15.97 mm along the x axis and downward 1.14 mm along the y axis. The greatest average movement was at the level of the upper incisal edge, 16.5 mm along the x axis and downward 1.94 mm along the y axis. At 1 year post-distraction, both orbitale and point A had advanced an additional 0.47 mm and 0.24 mm along the x axis and downward 0.58 mm and 1.78 mm along the y axis respectively. The upper incisal edge moved posterior 0.60 mm along the x axis and downward 3.46 mm along the y axis. At 5 years post-distraction, orbitale moved posterior 0.58 mm, point A advanced an additional 2.08 mm and the upper incisal point advanced 1.93 mm along the x axis. Orbitale, point A and upper incisal point moved downward 3.23, 5.20, and 6.35 along the y axis respectively. We also found that the maxillary and mandibular skeletal discrepancy improved over the 5 year period.