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Midfacial Distraction Without Osteotomy Using a Transfacial Pin and External Devices

Coeugniet, Edouard MD*†‡; Dhellemmes, Patrick MD, PhD; Vinchon, Mathieu MD, PhD; Wolber, Alexis MD; Pellerin, Philippe MD, PhD*†

Journal of Craniofacial Surgery: January 2012 - Volume 23 - Issue 1 - p 184–189
doi: 10.1097/SCS.0b013e3182418f80
Technical Strategies

Introduction During the 1970s, frontofacial advancement revolutionized the treatment of severe facial stenosis. Unfortunately, this method was associated with significant morbidity due to the Le Fort III osteotomy, which creates a major communication between the frontocranial dead space and the nasal fossae. Midfacial distraction improves the complication rate by diminishing the size of this gap. The aim of our study was to present an original technique that uses external distraction frames and eliminates the need for Le Fort osteotomies. This innovative technique eliminates the gap between the skull and nose, thus avoiding related complications.

Patients and Methods Between 1997 and 2008, we operated on 17 patients presenting midfacial retrusion and maxillomandibular class III malocclusion. We performed classic fronto-orbital advancement. The only facial osteotomies are vertical cuts of both the lateral orbital wall and the zygomatic arch. The distraction device is then anchored posteriorly with a K-wire and anteriorly with a transfacial pin through the maxilla. Finally, the distraction is performed horizontally until a class II overcorrection is obtained.

Results No life-threatening complications or mortalities occurred. In all cases, the midfacial retrusion was corrected without relapse. All patients with complications fully recovered. It was observed that most complications were a result of either an overly rapid activation (>1 mm/d).

Discussion Midface distraction using the external transfacial pin is a simple and safe procedure that allows an efficient correction of major facial retrusion. The external transfacial pin acts directly onto the maxilla and allows distraction without Le Fort osteotomy. By eliminating major osteotomies, it reduces the number of severe complications encountered in craniofacial surgery.

From the *National Center of Caniomaxillofacial Malformations, †Plastic Surgery Department, University Hospital Lille, Lille Cedex, France; ‡Plastic Surgery Department, University of Montreal Hospital Centre, Montreal, Quebec, Canada; and §Neurosurgery Department, University Hospital Lille, Lille Cedex, France.

Received January 3, 2011.

Accepted for publication July 31, 2011.

Address correspondence and reprint requests to Edouard Coeugniet, MD, Plastic Surgery Department, Hotel-Dieu Hospital, 3840 St Urbain, Montreal, Quebec, Canada H2W 1T8; E-mail:

The authors report no conflicts of interest.

© 2012 Mutaz B. Habal, MD