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Guérin J, Hennocq Q, Paternoster G, Arnaud É, Khonsari RH. Distractor position and distraction amplitude in fronto-facial monobloc advancement : A case series. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101942. [PMID: 38897383 DOI: 10.1016/j.jormas.2024.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
Fronto-facial monobloc advancement with internal distraction (FFMBA) is a central procedure in the management of faciocraniosynostoses. In techniques with internal distraction, two sets of devices are generally positioned: bilateral fronto-orbital and temporo-zygomatic distractors, using a temporal tongue and groove osteotomy design. It is believed that distractors must be positioned as parallel as possible in the horizontal and sagittal planes to avoid mechanical conflicts between the sliding bone fragments of the tongue and groove during distraction, and thus optimize the advancement amplitude. Several approaches involving surgical planification and guides for distractor positioning have thus been proposed to monitor distractor placement. To explore the need for surgical planification in distractor placement, the parallelism of the position of the 4 distractors was assessed in 19 FFMBA procedures and we correlated a set of 10 distractor angles with the degree of advancement. We report that the horizontal cut of the tongue and groove can be used as a landmark for the positioning of the lower, temporo-zygomatic, distractor in fronto-facial monobloc advancement. Other parameters (relative position of the two homolateral and the two contralateral distractors and the orientations of the vertical and horizontal cuts of the tongue and groove) do not interfere with distraction, other things being equal. Our results indicate that distractor orientation is not a critical issue in fronto-facial monobloc advancement when devices are positioned as parallel as possible based on visual monitoring.
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Affiliation(s)
- Jade Guérin
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Quentin Hennocq
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France; Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Giovanna Paternoster
- Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Éric Arnaud
- Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France; Clinique Marcel Sembat, Ramsay, Boulogne-Billancourt, France
| | - Roman Hossein Khonsari
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France; Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France.
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Burns HR, Wang DS, Abu-Ghname A, Dempsey RF. Craniofacial Distraction Osteogenesis. Semin Plast Surg 2023; 37:253-264. [PMID: 38098686 PMCID: PMC10718658 DOI: 10.1055/s-0043-1776298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Distraction osteogenesis (DO) of the craniofacial skeleton has become an effective technique for the treatment of both nonsyndromic and syndromic conditions. The advent of craniofacial DO has allowed for earlier intervention in pediatric patients with less complication risk and morbidity compared to traditional techniques. In this review, we will discuss current application and technique for craniofacial DO by anatomical region and explore future applications in craniofacial surgery.
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Affiliation(s)
- Heather R. Burns
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Daniel S. Wang
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Amjed Abu-Ghname
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Robert F. Dempsey
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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