Objective
This guideline provides recommendations for medical practice on suspicion of craniosynostosis and after confirmation of this diagnosis. It is based on the results of scientific research and subsequent forming of opinion by a multidisciplinary working group, composed of representatives of the medical specialties involved in the treatment of craniosynostosis, related professional disciplines, and other parties involved.

The wishes of parents and health professionals regarding the organization of health care for craniosynostosis were inventoried. The guideline document addresses the important issues for the support of parents with a child with a craniosynostosis.

/pdf/guideline-for-care-of-patients-with-the-diagnoses-of-18osvl2017.pdf

Guideline for Care of Patients With the Diagnoses of Craniosynostosis: Working Group on Craniosynostosis

Antibiotic prophylaxis against wound infections in oral and maxillofacial surgery.

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 ≤ 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.

Halo distraction of the Le Fort III in syndromic craniosynostosis : a long-term assessment

Antimicrobial prophylaxis for surgery

Background: Treatment of midface hypoplasia and forehead retrusion with monobloc advancement is associated with significant complications, including meningitis, prolonged intubation, and frontal bone flap necrosis. To see whether distraction of the monobloc segment offered decreased morbidity, the authors compared clinical outcomes of patients who underwent conventional monobloc advancement with those of patients who underwent monobloc distraction. Methods: Group 1 (conventional monobloc; n = 12) underwent traditional monobloc advancement with bone grafting. Group 2 (modified monobloc; n = 11) did not receive ventriculoperitoneal shunts and underwent the above procedures with placement of a pericranial flap and fibrin glue over the midline defect. Group 3 (monobloc distraction; n = 24) underwent advancement of the monobloc segment by distraction osteogenesis using internal distraction devices. Complications included meningitis, cerebrospinal fluid leak, frontal bone flap loss, and wound infection. Preoperative, postoperative, and follow-up lateral cephalograms were used to assess horizontal changes of the forehead, midface, and maxilla. Results: Group 3 (distraction monobloc) had the lowest complication rate (8 percent), followed by groups 2 (modified monobloc; 43 percent) and 1 (conventional monobloc; 61 percent) (p < 0.05). Group 3 achieved greater advancement (12.6 mm) than did group 2 (9.4 mm) or group 1 (9.1 mm) (p < 0.05). Relapse was least in group 3 (8 percent) compared with groups 2 (67 percent) and 1 (45 percent). Conclusions: Monobloc advancement by distraction osteogenesis had less morbidity and achieved greater advancement with less relapse compared with conventional methods of acute monobloc advancement with bone grafting. Monobloc distraction is superior to conventional methods of acute monobloc advancement and is an alternative to staged fronto-orbital advancement followed by Le Fort III advancement.

Monobloc advancement by distraction osteogenesis decreases morbidity and relapse

In 1983, we evaluated the stability of midface position after Le Fort III advancement for midface hypoplasia secondary to Crouzon's or Apert's syndromes. The patients were operated upon from 1972 to 1980, and mean follow-up was 5.8 years (Kaban et al, 1984). In this study, we present an additional 3 1/2 year follow-up of these patients to look at what happens to midface position after Le Fort III osteotomy in growing and nongrowing patients.

/pdf/midface-position-after-le-fort-iii-advancement-a-long-term-41zregnltj.pdf

Midface position after Le Fort III advancement: a long-term follow-up study.

Nineteen of 30 patients who had midface advancement procedures between 1972 and 1980 had sufficient cephalometric data to be included in this retrospective study. The position of the midface in relation to the cranium and mandible was evaluated immediately postoperatively and for a period of 2 to 11 years (mean 5.8 years). At 1 year, midface position after LeFort III advancement was stable in 12 of 19 patients. Of these 12 patients, 8 showed some evidence of downward and/or forward movement of the midface. The remaining 7 patients showed a minor degree of midface relapse in the first year of follow-up. In 15 of 19 patients, at 2 years or more postoperatively, the final position of the midface was either at, anterior to, or inferior to its immediate postoperative location. Correction of exorbitism remained stable in all but one patient, who required a second advancement of the orbital segment. Three patients required subsequent LeFort I osteotomy to correct class III occlusion. Prognathism was determined to be secondary to mandibular growth, not midface relapse.

Midface Position after Lefort Iii Advancement

Antibiotic prophylaxis for major maxillocraniofacial surgery.

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Midface position after Le Fort III advancement: a long-term follow-up study.

Midface Position after Lefort Iii Advancement

Antibiotic prophylaxis for major maxillocraniofacial surgery.