Long-Term Follow-Up on Bone Stability and Complication Rate after Monobloc Advancement in Syndromic Craniosynostosis.

Abstract

BACKGROUND:

Monobloc advancement is a complex procedure used to treat patients with syndromic craniosynostosis. Studies directly addressing the long-term stability of monobloc advancement with distraction osteogenesis are underreported in the literature. The objectives of this study were to assess 5-year midface bone stability following monobloc advancement performed on patients with syndromic craniosynostosis, identify risk factors for relapse, and present strategies for prevention and management of complications.

METHODS:

An observational retrospective study was performed on consecutive patients with Apert, Crouzon, or Pfeiffer syndrome (n = 23) who underwent monobloc advancement using distraction osteogenesis between 1994 and 2013. A total of 130 lateral cephalograms were used to assess both long-term stability after monobloc advancement with distraction osteogenesis and risk factors for relapse. All serious complications were identified and recorded. The analysis of variance test was used to assess horizontal relapse of the midface and mandibular plane.

RESULTS:

Cephalometric analysis revealed long-term stability of frontofacial advancement using distraction osteogenesis, regardless of the presence of tested variables. Serious complications arising from monobloc advancement using distraction osteogenesis included cerebrospinal fluid leakage in six patients (26 percent), accompanying meningitis in two patients (8.7 percent), seizures in seven patients (30.4 percent), and impaired visual acuity in one eye of one patient (4.3 percent).

CONCLUSION:

Frontofacial monobloc advancement with distraction osteogenesis provides long-term midface bone stability.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.

• Authors: Cassio Eduardo Raposo-Amaral, Rafael Denadai, Guilherme Luis Zanco, Enrico Ghizoni, Cesar Augusto Raposo-Amaral
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 145 Issue 4 Pg. 1025-1034 (04 2020) ISSN: 1529-4242 [Electronic] United States
• PMID: 32221227 (Publication Type: Journal Article, Observational Study)

Topics

• Acrocephalosyndactylia (surgery)
• Adolescent
• Adult
• Blood Transfusion (statistics & numerical data)
• Cephalometry
• Child
• Craniosynostoses (surgery)
• Facial Bones (physiology)
• Female
• Follow-Up Studies
• Humans
• Male
• Osteogenesis, Distraction (adverse effects, methods)
• Postoperative Complications (etiology)
• Recurrence
• Retrospective Studies
• Risk Factors
• Syndrome
• Treatment Outcome
• Young Adult