Alonso Nivaldo, Goldenberg Dov, Fonseca Alexandre S, Kanashiro Eduardo, Matsushita Hamilton, Freitas Renato da Silva, Shin Joseph H
Division of Plastic Surgery, São Paulo University, São Paulo, Brazil.
J Craniofac Surg. 2008 Jul;19(4):1170-3. doi: 10.1097/SCS.0b013e318176ac83.
The monobloc frontofacial osteotomy provides aesthetic and functional improvement in the treatment of various craniofacial deformities. This procedure, through highly complex, has had some significant associated complication, such as cerebrospinal fluid leakage, hematoma, infection, and bone resorption. Distraction has been successfully used to gradually elongate bone and soft tissue. This method seems to provide improved results over conventional surgery, with less morbidity. We present a case of a patient with Apert syndrome who underwent monobloc advancement using the Rigid External Device (RED) device and who developed a transient bilateral amaurosis on the fourth postoperative day before distraction. A second procedure was performed to push back the frontal bandeau, maintaining the device in position. The blindness was resolved with this procedure as well as treatment with systemic steroids. The distraction was started thereafter, and the desired improvement was acquired. To our knowledge, this is the first case of transient bilateral amaurosis in a patient undergoing monobloc distraction.
整块额面截骨术在治疗各种颅面畸形方面可改善美观和功能。该手术尽管极其复杂，但存在一些严重的相关并发症，如脑脊液漏、血肿、感染和骨吸收。牵引成骨已成功用于逐渐延长骨骼和软组织。这种方法似乎比传统手术效果更好，发病率更低。我们报告一例患有Apert综合征的患者，该患者使用坚固外固定装置（RED）进行整块前移术，在牵引前术后第四天出现短暂性双侧黑矇。随后进行了第二次手术，将额骨带向后推，同时保持装置在位。通过该手术以及全身类固醇治疗，失明得以解决。此后开始牵引，获得了预期的改善。据我们所知，这是首例在接受整块牵引的患者中出现短暂性双侧黑矇的病例。
