Outcome of early rigid fixation and removal of rigid external distraction system after distraction osteogenesis of the midface

Abstract

After distraction osteogenesis of the midface using a rigid external distraction (RED) system, there is a high possibility that a relapse might occur due to an incomplete fixation during the consolidation period, and it is uncomfortable for the patients to wear a head frame for 2 to 3 months. There are also risks of trauma that are developing. To overcome these problems, we suggest the protocol of early rigid fixation, with excellent treatment outcomes and a review of literatures. Of 9 patients, Le Fort III osteotomy was completed in 2 patients with Crouzon disease, and a Le Fort I osteotomy was completed in 7 patients with a cleft lip and palate. Immediately after the distraction with RED was completed, the fixation was done using a miniplate. This was followed by the early removal of the RED system. In patients who underwent the current procedure, an analysis was performed for the degree and the duration of distraction and the period of use of the RED system. Then, the presence of relapse was examined. The mean degree of bone distraction was found to be 18.05 mm (range, 9-31.5 mm). The mean period of wearing RED system was 29.78 days (range, 21-43 days). Thereafter, the mean follow-up period was 13 months (range, 6 months to 3 years). The degree of accumulated relapse was found to be 1.7 mm (10%) on postoperative year 1, 2.4 mm (13.3%) on postoperative year 2, and 2.3 mm (14.6%) on postoperative year 3. With the concept of early rigid fixation, we were able to eliminate the disadvantages of distraction osteogenesis such as the long period of wearing a head frame, the delay of returning to society, and the inconvenience of patients. Moreover, early rigid fixation could decrease the need of overcorrection and the amount of relapses.