Expanding the middle third of the face by distraction osteogenesis in apert patients

Cranial deformities often require major surgical procedures to be corrected. Plastic surgeon Paul Tessier, a pioneer in the evolution of craniofacial surgery, insists that the guiding principle in the treatment of craniosinostoses is to separate the splancocranium from the neurocranium and move the splancocranium into a more anatomically correct position. This is still the main procedure of today, but the recent use of bone distraction devices has significantly changed surgical techniques. Two children affected by Apert's syndrome were operated on by performing a Lefort III osteotomy and applying Molina's bone distractors in order to obtain the "push" technique. The activation period lasted six weeks at which time the patient was required to wear a modified facial mask in order to control the amount of "pull" forward distraction. The distractors were removed after the 8-week consolidation period had expired. Postoperative clinical and instrumental (CT-scan) evalution showed a remarkable improvement of midfacial hypoplasia with correction of the exophtalmus, advancement of the nasal pyramid and an increase in facial length. CT scans also showed the formation of new good quality bone. Gradual advancement of the facial skeleton by distraction avoids the need for bone grafting and rigid fixation. Results are safer and aesthetic appearance is improved due to a guided bone expansion which gradually pushes and stretches soft tissues resulting in the entire midface to be expanded in a more harmonious manner.