Introduction: Complex faciocraniosynostoses require a multidisciplinary approach and multiple complex surgeries to address all functional problems. In the first years of age, an early monobloc procedure has some surgical setbacks. The principle of external traction has been proved useful in extreme mandibular hypotrophy. A frontofacial or a facial advancement, associating internal distraction and a traction system by the means of a Kirschner’s transfacial wire has been developed.
Methods: Between March 2008 and July 2016, eleven patients (6 Pfeiffer, 3 Crouzon and one with an Antley-Bixler syndromes) have been operated (12 procedures) on according to the following technique: Frontofacial monobloc or Le Fort 3 or Bi-bloc (combination of Frontoorbital advancement and Le Fort 3) were performed. A transzygomatic K-wire (Kirshner 2-2,2 mm) was inserted after osteotomies. An external traction by the means of pulleys and string (3kg) was installed under continuous sedation during the first 7 days, followed by a traditional internal distraction and consolidation (3–6 months). Median age was 1,54 ± 1,1 years. Median follow-up was 5,2 ± 2,1 years.
Results: Exorbitism improved in all patients. All patients were free of ventilatory assistance postoperatively. Fifty per cent of tracheotomized patients were decanulated. One year postoperatively, all patients had a better occlusion. At 5 years of follow-up, 57% were in Class II. Two complications occurred: one pin-tract infection was solved after removal of the pin and one transient brachial plexus palsy due to overextension of the neck during traction.
Discussion: The traction/distraction system is a reliable ancillary procedure for the very young patients with faciocraniostenoses in whom an early progressive facial advancement is mandatory. A longer follow-up and a greater series of patients is advisable for to confirm this technique in less complex cases. Major dental damage occurred because of pin insertion through tooth buds, but this technique was adequate as an eye-saving procedure in extreme exorbitism.