Comparison of Internal and External Distraction in Frontofacial Monobloc Advancement: A Three-Dimensional Quantification.

Autor:	Rickart AJ; From the UCL Great Ormond Street Institute of Child Health.; Craniofacial Unit, Great Ormond Street Hospital for Children., van de Lande LS; From the UCL Great Ormond Street Institute of Child Health.; Craniofacial Unit, Great Ormond Street Hospital for Children., O' Sullivan E; Department of Computing, Imperial College London., Bloch K; Unité de Chirurgie Cranio-faciale, Service de Neurochirurgie, Centre de Référence Maladies Rares Craniosténoses et Malformations Craniofaciales (CRANIOST), Hôpital Necker-Enfants Malades, Assistance Publique.; Faculté de Médecine, Université de Paris., Arnaud E; Unité de Chirurgie Cranio-faciale, Service de Neurochirurgie, Centre de Référence Maladies Rares Craniosténoses et Malformations Craniofaciales (CRANIOST), Hôpital Necker-Enfants Malades, Assistance Publique.; Faculté de Médecine, Université de Paris., Schievano S; From the UCL Great Ormond Street Institute of Child Health.; Craniofacial Unit, Great Ormond Street Hospital for Children., Jeelani NUO; From the UCL Great Ormond Street Institute of Child Health.; Craniofacial Unit, Great Ormond Street Hospital for Children., Paternoster G; Unité de Chirurgie Cranio-faciale, Service de Neurochirurgie, Centre de Référence Maladies Rares Craniosténoses et Malformations Craniofaciales (CRANIOST), Hôpital Necker-Enfants Malades, Assistance Publique.; Faculté de Médecine, Université de Paris., Khonsari R; Unité de Chirurgie Cranio-faciale, Service de Neurochirurgie, Centre de Référence Maladies Rares Craniosténoses et Malformations Craniofaciales (CRANIOST), Hôpital Necker-Enfants Malades, Assistance Publique.; Faculté de Médecine, Université de Paris., Dunaway DJ; From the UCL Great Ormond Street Institute of Child Health.; Craniofacial Unit, Great Ormond Street Hospital for Children.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery [Plast Reconstr Surg] 2023 Sep 01; Vol. 152 (3), pp. 612-622. Date of Electronic Publication: 2023 Feb 28.
DOI:	10.1097/PRS.0000000000010331
Abstrakt:	Background: Crouzon syndrome is characterized by complex craniosynostosis and midfacial hypoplasia. Where frontofacial monobloc advancement (FFMBA) is indicated, the method of distraction used to achieve advancement holds an element of equipoise. This two-center retrospective cohort study quantifies the movements produced by internal or external distraction methods used for FFMBA. Using shape analysis, this study evaluates whether the different distraction forces cause plastic deformity of the frontofacial segment, producing distinct morphologic outcomes. Methods: Patients with Crouzon syndrome who underwent FFMBA with internal distraction [Hôpital Necker-Enfants Malades (Paris, France)] or external distraction [Great Ormond Street Hospital for Children (London, United Kingdom)] were compared. Digital Imaging and Communications in Medicine files of preoperative and postoperative computed tomographic scans were converted to three-dimensional bone meshes and skeletal movements were assessed using nonrigid iterative closest point registration. Displacements were visualized using color maps and statistical analysis of the vectors was undertaken. Results: Fifty-one patients met the strict inclusion criteria. Twenty-five underwent FFMBA with external distraction and 26 with internal distraction. External distraction provides a preferential midfacial advancement, whereas internal distractors produce a more positive movement at the lateral orbital rim. This confers good orbital protection but does not advance the central midface to the same extent. Vector analysis confirmed this to be statistically significant ( P < 0.01). Conclusions: Morphologic changes resulting from monobloc surgery differ depending on the distraction technique used. Although the relative merits of internal and external distraction still stand, it may be that external distraction is more suited to addressing the midfacial biconcavity seen in syndromic craniosynostosis. Clinical Question/level of Evidence: Therapeutic, III. (Copyright © 2023 by the American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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