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Retrospective Review of the Complication Profile Associated with 71 Subcranial and Transcranial Midface Distraction Procedures at a Single Institution

Zhang, Rosaline S., B.A.; Lin, Lawrence O., B.S.; Hoppe, Ian C., M.D.; Swanson, Jordan W., M.D.; Bartlett, Scott P., M.D.; Taylor, Jesse A., M.D.

Plastic and Reconstructive Surgery: February 2019 - Volume 143 - Issue 2 - p 521–530
doi: 10.1097/PRS.0000000000005280
Pediatric/Craniofacial: Original Articles

Background: This study characterizes the perioperative morbidity of a large cohort of subjects with syndromic craniosynostosis who underwent transcranial or subcranial midface distraction.

Methods: Demographic and perioperative data were compared between those who underwent transcranial or subcranial midface distraction osteogenesis between July of 1999 and December of 2017. Univariate analysis was conducted using chi-square and Fisher’s exact tests for categorical variables and the Mann-Whitney U test for continuous variables. Multivariate analysis was conducted using logistic regression modeling. Complications were graded using the Clavien-Dindo classification.

Results: Sixty-four subjects underwent a total of 71 midface distraction procedures. There was a total of 28 complications (39 percent). The trans cranial cohort had a significantly higher frequency of complications (58 percent) compared with the subcranial cohort (29 percent; p = 0.017), with a significantly greater proportion of infection-related complications in the transcranial cohort (80 percent versus 54 percent; p = 0.028). Transcranial complications included cranial contamination, whereas most subcranial cohort infections were superficial or limited facial abscesses. The only significant predictor variable for complications in a multivariate analysis was whether the osteotomy approach was transcranial as opposed to subcranial, with an odds ratio of 5.80 (p = 0.013).

Conclusions: Complication rates in midface distraction remain high, with transcranial procedures having significantly higher complication rates, infection-related complications, and notably greater severity of complications. Although the goals of surgery often dictate choice of osteotomy, the risks associated with transcranial procedures must be thoroughly understood by surgeon and patient alike.


Philadelphia, Pa.

From the Division of Plastic Surgery, Children’s Hospital of Philadelphia.

Received for publication February 23, 2018; accepted June 4, 2018.

Disclosure: None of the authors has a financial interest in any of the products or devices mentioned in this article.

Jesse A. Taylor, M.D., Department of Surgery, Children’s Hospital of Philadelphia, University of Pennsylvania, Colket Translational Research Building, 9th Floor, Philadelphia, Pa. 19104,

©2019American Society of Plastic Surgeons