Michael G. Cedars’s research while affiliated with Children's Hospital & Research Center Oakland and other places

Fourteen patients underwent Le Fort III midface advancement using distraction techniques. Six have cephalometric documentation extending beyond 1 year postoperatively, and the positions of cephalometric points A and orbitale over time are reported here. Excellent stability of advancement at the occlusal level and some relapse at the level of orbitale are documented. Elimination or diminution of obstructive sleep apnea occurred in all patients so affected, and one of two patients with tracheostomy has been decannulated. Speech effects have been mild or transient. No untoward effects on extraocular muscle function have occurred.

The purpose of this study was to demonstrate the potential advantages of applying distraction osteogenesis techniques to the correction of orbital and midfacial hypoplasia in craniosynostosis syndromes. Fifteen children with various craniosynostosis syndromes underwent Le Fort III advancement assisted by gradual distraction utilizing a pair of internal distraction devices custom-fabricated for each child. The surgical procedure consisted of a Le Fort III osteotomy, implantation of internal devices with initiation of distraction intraoperatively, and an accelerated rate of midfacial advancement over the next 3 to 5 days. Activation of the distraction hardware was accomplished by a percutaneous pin, which was removed at the end of the distraction protocol, allowing the internal devices to fixate the fragment for a minimum of 6 months during the period of consolidation. With follow-up ranging between 3 to 38 months, the average orbital and midfacial advancement was 19.7 mm (range, 12.0-30.0 mm). Proptosis was lessened and facial proportions significantly improved in all patients. Serious complications were not encountered. The modified distraction protocol utilized in this group of patients was aimed at addressing the unique requirements of pediatric craniofacial surgery, and resulted in almost twice the amount of correction previously reported for traditional rigid fixation techniques.