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Distraction of the Craniofacial Skeleton in the Organ Transplant Patient
Shawkat Sati, Jenny T Chen, Roberto Flores, Robert Havlik
Indiana University, Division Of Plastic Surgery, Craniofacial Unit
2010-03-31
Presenter: Jenny Chen, BS
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background:
Solid organ transplant patients are fated to immunosuppressive therapy which can lead to rapid bone loss, high fracture rates, and other skeletal framework complications. There are no reports in the literature describing craniofacial distraction in the setting of systemic immunosuppression for solid organ transplantation. We report the first case of a LeFort III distraction with a solid organ transplant.
Method:
A 4 year old female with Pfeiffers Syndrome and severe midface hypoplasia presents for craniofacial reconstruction. She had previously undergone heart transplantation for hypoplastic left heart syndrome. Her immunosuppressive therapy included Azathioprine and Tacrolimus. She had previously undergone a failed LeFort III distraction and an anterior cranial vault reconstruction. She had severe obstructive sleep apnea (Apnea-Hypoapnea Index: 61). She underwent a LeFort III osteotomy with placement of an external distractor (R.E.D. device) with a latency period of 4 days, activation period of 1mm per day for 16 days, and 60 days of consolidation. Lateral cephalograms were obtained on distraction days 0, 7, 14, and 21.
Result:
The patient underwent subcranial LeFort III distraction without complication. The midface was advanced 16mm. A high resolution 3D CT scan revealed good bone formation at the distraction sites, with a clinically stable construct. There was no relapse at 6 months.
Conclusion:
We report the first successful craniofacial skeletal distraction in the setting of systemic immunosuppression for solid organ transplantation. Despite current literature suggesting poor bone formation and osteoporosis secondary to immunosuppressive therapy, distraction biology permits formation of clinically stable construct.
