Comparative Study of Internal Device versus External Device in Le Fort III Distraction for Syndromic Craniosynostosis.

BACKGROUND

Le Fort III distraction for syndromic craniosynostosis is performed using internal or external devices. The authors compared the results of both devices.

METHODS

The authors retrospectively evaluated 60 patients with syndromic craniosynostosis treated with Le Fort III distraction (internal or external device) between 2001 and 2021. The authors verified demographic data, surgery-related data, and complications using medical records. For each of the 2 devices, they compared the various factors associated with the device to each other.

RESULTS

For the external device, 32 patients with syndromic craniosynostosis were included. The mean age at surgery was 11.7 years, and the mean elongation length was 20.0 mm. Class III occlusion reoccurred in 11 patients and was significantly associated with age at surgery. Seven complications (device problems and others) were noted. Cranial pin slippage was significantly related to the elongation length. For the internal device, 28 patients with syndromic craniosynostosis were included. The mean age at surgery was 10.4 years, and the mean elongation length was 18.7 mm. There were 15 complications, including device problems, zygomaticomaxillary fractures, and infections. Elongation length was significantly related to these complications. Class III occlusion reoccurred in 9 patients and was significantly related to age at surgery.

CONCLUSIONS

This study found that complications are significantly more likely to occur in internal devices than in external devices, especially device infection. The authors' findings identified several factors that may assist surgeons in selecting between external and internal devices. The relationship between the amount of extension and device-related problems found in this study will be beneficial for solving these problems.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.