Rigid External Distractor Aided Conventional Le Fort III Osteotomy Advancement in Adult With Severe Midfacial Hypoplasia.

Background: Management of severe midfacial hypoplasia is still a challenge for craniofacial team, adult patients with syndromic midfacial hypoplasia made the situation even worse. The authors present the clinical result in an adult patient with Crouzon syndrome treated by rigid external distractor aided conventional Le Fort III procedure.

Methods: A 26-year-old patient with Crouzon syndrome presented with severe midfacial hypoplasia, a negative overjet of -17 mm, exorbitism, airway obstruction, and masticatory problem, while chief complaint of the patient was abnormal appearance. After Le Fort III osteotomy, rigid external distractor and distraction hooks were fixed. With the aid of rigid external distractor, the midfacial mass was immediately advanced to a desired position, allograft bone grafted in the gaps, and microplate fixed. The device was removed 3 weeks later when the advanced midface was stable.

Results: Point A was advanced by 18.6 mm in horizontal and displaced superiorly 0.5 mm in vertical at the time of device removal. Point A moved backward 1.5 mm and upward 0.3 mm at 2-year follow-up. A good and balanced facial profile was obtained in a short treatment period. Airway obstruction symptoms and exorbitism were relieved.

Conclusions: The midfacial advancement achieved by rigid external distractor aided conventional Le Fort III osteotomy is a stable, controllable, and timesaving procedure. This technique may become an important choice for adult patients with severe midfacial hypoplasia.