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Simultaneous and Differential Fronto-orbital and Midface Distraction Osteogenesis for Syndromic Craniosynostosis Using Rigid External Distractor II

Medra, Ahmed Mohamed MD*; Marei, Ahmed Gaber MD; Shehata, Ehab Ali MD*; McGurk, Mark MD; Habib, Ahmed MD*

doi: 10.1097/SCS.0b013e3182565599
Original Articles

In syndromic craniosynostosis, the relation between the supraorbital area and the frontal bone is not good, and it is not possible to reform this area with 1-block advancement. To avoid this problem, the frontal bone is separated from the fronto-orbital bandeau, each is reshaped and remodeled separately, and then both are reattached.

The retrusion of the midface, especially in syndromic craniosynostosis, is usually greater than that of cranial bones, so the technique usually separating the midface from the cranium is Le Fort III osteotomy, which allows differential distraction of each part.

In this procedure, the cranial and midfacial bones are advanced simultaneously and differentially, both to the planned extent, in a single-stage operation, using rigid external distractor II, correcting exorbitism, respiratory embarrassment, and cranial structures and avoiding eye complications in the future. This procedure was used, with a follow-up, in 10 patients with syndromic craniosynostosis from 2 to 5 years.

From the *Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, †Department of Neurosurgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt; and ‡Department of Oral and Maxillofacial Surgery, Guy’s Hospital, University of London, UK.

Received September 23, 2011.

Accepted for publication March 19, 2012.

Address correspondence and reprint requests to Prof. Ahmed Mohamed Medra, Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Shamplioon Street, Azarita, Alexandria, 21599 Egypt; E-mail:

The authors report no conflicts of interest.

© 2012 Mutaz B. Habal, MD