Craniofacial Distraction in Infancy and Early Childhood

Le Fort I, II, and III, as well as monobloc distraction osteogenesis (DO), is a powerful tool in the craniofacial armamentarium that is most often employed to treat patients with craniofacial syndromes such as Crouzon, Apert, or Pfeiffer syndrome who present with midfacial retrusion, shallow orbits, exorbitism, malocclusion, obstructive sleep apnea, and facial imbalance. The Le Fort III advancement enables the advancement of the whole viscerocranial area, whereas the monobloc advancement is aimed to also extend the anterior skull block. Le Fort III distraction was first described in 1950 and has since become a key technique in the armamentarium of craniofacial surgeons. Le Fort II distraction with zygomatic repositioning is a modification of the Le Fort III distraction operation aimed to correct abnormal facial ratios of patients with greater central than lateral midface deficiency. A high Le Fort I distraction is indicated when the hypoplasia is concentrated on the maxilla and lower nasal part. The application of distraction osteogenesis to the craniofacial skeleton has allowed for large movements to be performed safely in young patients. The timing and indication for the chosen distraction technique depend on the individual patients’ situation. It is used for correcting airway obstruction owing to midface retrusion, exorbitism, and maxillary hypoplasia-related swallowing and speaking problems. It can be performed with either an external distractor or an internal distractor. Although serious complications have been reported, these occur rarely when performed by experienced providers.