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Normalizing Facial Ratios in Apert Syndrome Patients with Le Fort II Midface Distraction and Simultaneous Zygomatic Repositioning

Hopper, Richard A. M.D., M.S.; Kapadia, Hitesh D.D.S., Ph.D.; Morton, Trent B.S.

Plastic & Reconstructive Surgery: July 2013 - Volume 132 - Issue 1 - p 129–140
doi: 10.1097/PRS.0b013e318290fa8a
Pediatric/Craniofacial: Original Articles
Expert

Background: Le Fort III distraction advances the Apert midface but leaves the central concavity and vertical compression untreated. The authors propose that Le Fort II distraction and simultaneous zygomatic repositioning as a combined procedure can move the central midface and lateral orbits in independent vectors in order to improve the facial deformity. The purpose of this study was to determine whether this segmental movement results in more normal facial proportions than Le Fort III distraction.

Methods: Computed tomographic scan analyses were performed before and after distraction in patients undergoing Le Fort III distraction (n = 5) and Le Fort II distraction with simultaneous zygomatic repositioning (n = 4). The calculated axial facial ratios and vertical facial ratios relative to the skull base were compared to those of unoperated Crouzon (n = 5) and normal (n = 6) controls.

Results: With Le Fort III distraction, facial ratios did not change with surgery and remained lower (p < 0.01; paired t test comparison) than normal and Crouzon controls. Although the face was advanced, its shape remained abnormal. With the Le Fort II segmental movement procedure, the central face advanced and lengthened more than the lateral orbit. This differential movement changed the abnormal facial ratios that were present before surgery into ratios that were not significantly different from normal controls (p > 0.05).

Conclusion: Compared with Le Fort III distraction, Le Fort II distraction with simultaneous zygomatic repositioning normalizes the position and the shape of the Apert face.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Seattle, Wash.

From the Division of Plastic Surgery, University of Washington; and the Craniofacial Center, Seattle Children’s Hospital.

Received for publication November 16, 2012; accepted January 28, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Richard A. Hopper, M.D., Craniofacial Center, Division of Plastic Surgery, Seattle Children’s Hospital, 4800 Sand Point Way NE, Mailstop W7847, Seattle, Wash. 98105, richard.hopper@seattlechildrens.org

©2013American Society of Plastic Surgeons