Monobloc Distraction Osteogenesis in Pediatric Patients With Severe Syndromal Craniosynostosis
Autor: | Kjartan Arctander, Per Skjelbred, Torstein R. Meling, Hans Erik Høgevold, Bernt J. Due-Tønnessen |
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Rok vydání: | 2004 |
Předmět: |
Reoperation
medicine.medical_specialty Blood transfusion Adolescent Exophthalmos medicine.medical_treatment Osteogenesis Distraction Facial Bones Craniosynostosis Craniosynostoses Postoperative Complications Distraction medicine Humans Craniofacial Child Monobloc business.industry Infant General Medicine Perioperative Plastic Surgery Procedures medicine.disease Surgery Airway Obstruction Otorhinolaryngology Child Preschool Distraction osteogenesis medicine.symptom business |
Zdroj: | Journal of Craniofacial Surgery. 15:990-1000 |
ISSN: | 1049-2275 |
Popis: | The management of the hypoplastic midface in syndromic craniosynostosis remains a great challenge. Frequently, patients have to be operated on numerous times to achieve a satisfactory end result, partially because of the limited skeletal advancement possible when using traditional surgical techniques. During the last decade, however, methods for gradual midfacial distraction have been presented, whereby greater advancements can be obtained. We present four children aged 17 months to 15 years with severe syndromal craniosynostosis in need of midface advancements because of severe respiratory obstruction or severe exophthalmos. These patients were complex cases with several previous craniofacial surgeries (mean of three times, range of two to six times) that yielded insufficient skeletal advancements. They were operated on with gradual monobloc advancements using the Modular Internal Distraction System. The mean length of operations was 370 minutes (range: 240-455 minutes), and the mean amount of perioperative blood transfusion needed was 1,300 ml (range: 280-2,700 ml) or 66.9 ml/kg (range: 31.1-94.9 ml/kg). The patient with the greatest number of previous operations also had the longest operation time as well as the most blood loss. The average midface advancement obtained was 25 mm (range: 20-30 mm), resulting in cessation or a significant decrease of preoperative respiratory problems, reduced exophthalmos, and improved facial profile. Apart from a local infection in one patient with a connective tissue disorder and several previous wound infections, no major postoperative complications were recorded. Distraction osteogenesis has become a versatile and safe technique that allows for large advancements of the midface. |
Databáze: | OpenAIRE |
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