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  • Title: Halo distraction of the Le Fort III in syndromic craniosynostosis: a long-term assessment.
    Author: Fearon JA.
    Journal: Plast Reconstr Surg; 2005 May; 115(6):1524-36. PubMed ID: 15861055.
    Abstract:
    BACKGROUND: Little is known about long-term outcomes after Le Fort III halo distraction, such as indications for distraction, amount of relapse, and long-term maxillary growth. METHODS: During a 5-year period, 51 Le Fort III osteotomies were performed; 41 of these were by halo distraction for the treatment of craniofacial dysostosis (Apert syndrome, 25; Crouzon syndrome, nine; Pfeiffer syndrome, four; other, three). Patient records were reviewed and 104 cephalograms were analyzed. RESULTS: The average treatment age was 8 years, and the average hospitalization was 5.3 days (3.6 days for the second half of this series). The average distraction was 26 mm (range, 14 to 44 mm), the sella-nasion-subspinale angle increased from 70 degrees to 87 degrees, the upper incisal edge advanced 18 mm, and the vertical distance between nasion and point A increased by 7 mm. There was no maxillary relapse at 1 year and no measurable forward maxillary growth for up to 5 years, although the maxilla did grow vertically (p < or = 0.001). Three patients underwent tracheostomy removal; sleep studies showed the average respiratory disturbance index improved from 24 to 11 (p = 0.004) and the minimum oxygen saturation increased from 81 to 89 (p = 0.006). Three early patients had incomplete advancements. CONCLUSIONS: The maxilla remained stable after Le Fort III halo distraction without any relapse, and no anterior growth was observed up to 5 years postoperatively. This procedure effectively eliminated sleep apnea in most children, and had a low overall complication rate that declined with experience. Most distracted patients will likely avoid the traditional second Le Fort III.
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