Midfacial distraction using a transfacial pinning technique for syndromic craniosynostosis with obstructive respiratory disorders.

Abstract

Syndromic craniosynostosis is known to be associated with various obstructive respiratory disorders including sleep apnoea. We performed early midfacial distraction using a transfacial pinning technique in five syndromic craniosynostotic patients with obstructive respiratory disorders. Here, we report good results, indications and usefulness of this procedure. The subjects were five young children aged 7 months to 2 years who had respiratory disorders since birth due to midface hypoplasia. All subjects underwent midfacial distraction to avoid tracheotomy. The method involved Le Fort III osteotomy followed by the use of our original transfacial pinning system. This system consisted of devices connecting (1) transfacial pins penetrating the bilateral zygomatic bones and (2) Kirschner wires, which were passed through plates fixed on the bilateral temporal bones. The maxilla was distracted anteriorly at least 20 mm. Distraction was evaluated by comparing the pre- and postoperative polysomnography (PSG) and cephalograms. All patients had markedly improved respiratory conditions after distraction, and a tracheotomy was avoided. Postoperative PSG and cephalograms also showed great improvements compared with preoperative findings. A transfacial pinning system was considered useful and can be the most suitable method for early midfacial distraction in syndromic craniosynostosis with obstructive respiratory disorders.