<< Back to the abstract archive
Radical Bi-Maxillary Distraction in Severe Mandibulofacial Dysostosis
Christopher Runyan MD, PhD
Christopher Gordon MD
University of Cincinnati
2015-03-15
Presenter: Christopher Runyan
Affidavit:
Dr Runyan performed most of the data collection and analysis. Dr. Gordon provided conceptual direction and data analysis/interpretation.
Director Name: W John Kitzmiller
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction
Patients with severe Nager and Treacher Collins (TCS) syndromes present a distinct challenge to craniofacial surgeons due to micrognathia and airway obstruction that frequently persist despite mandible distraction osteogenesis (MDO). In our experience the massive mandibular movements required to clear the airway using a two-pin transfacial approach requires forces that often result in hardware failure or patient discomfort. We hypothesized that bi-maxillary distraction using a rigid external device (RED) would facilitate greater and more stable mandibular advancements.
Methods & Results
Consecutive cases (8) of children with severe TCS or Nager syndrome treated with Lefort III/BSSO distraction osteogenesis were examined. Six had a prior MDO operation and 6 had a tracheostomy. Prior to Lefort III, malar and periorbital augmentation were performed using BMP2-soaked particulate allograft bone. This was performed serially (up to 4 times). Using an ultrasonic osteotome, concomitant transconjunctival Lefort III and BSSO were then performed and distracted to a RED device at both levels at 1mm/day. We overdistracted to promote airway clearance and utilized a consolidation period and/or intermaxillary fixation following distraction. Significant midface soft tissue advancement often required subsequent canthoplasty (6), midface bony contouring (7) or nasal dorsum augmentation with rib graft (3). Three patients required a second bimaxillary advancement. Of the patients with tracheostomy half (3) are decannulated and another two are receiving capping trials.
Conclusion
Based upon our experience, aggressive bimaxillary distraction with stable counterclockwise maxillary movement has greater success than isolated/serial MDO for treatment of upper airway obstruction in patients with severe mandibulofacial dysostosis.
