Midface distraction in infants without osteotomies using a transmaxillary pin and custom made footplates

Introduction: Midfacial hypoplasia has been traditionally treated with Le Fort III advancement osteotomies and bone grafts. Early intervention is often indicated in cases of upper respiratory obstruction and severe proptosis. Traditional surgical procures require a prolonged operation time, several osteotomies with a significant blood loss, and wide surgical exposure. Midface distraction without osteotomies has been successfully performed in canines. Fairley et al., Alonso et al. and Pellerin have all reported their experiences with midface distraction without osteomies or with partial osteotomies in patients with craniofacial deformities.

Materials and methods: External distraction devices are used in conjunction with a transmaxillary Steinman pin and two custom-made chrome cobalt footplates. These chrome cobalt footplates are made by a dental technician using grid retention and 2 mm sprue wax. Footplates are fixed to the temporal bones with 4 mm self-tapping titanium screws. Distraction is commenced on day 3 post-operatively with a 30° downward vector. The distraction rate is 0.5 mm once daily.

Results: Case reports of midface distraction without osteomies in infant patients will be presented. Total distraction of a minimum of 20 mm can easily be reached. Slight overcorrection is advised. All hardware is removed after a consolidation phase. Post surgical CT measurements confirmed clinical results.

Conclusion: Midface distraction using a transmaxillary pin and custom made footplates is a safe and effective minimal invasive procedure in very young children. Our limited experience shows that midface distraction without osteotomies becomes more difficult with age.

Conflict of interest: None declared.

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Jan 27, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Midface distraction in infants without osteotomies using a transmaxillary pin and custom made footplates
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