Le Fort III Distraction Osteogenesis Without Bicoronal Incision.

PURPOSE: Recently, midfacial hypoplasia for syndromic craniosynostosi has been corrected by Le Fort III distraction osteogenesis. During conventional Le Fort III osteotomy, osteotomy is performed via bicoronal incision. In contrast, the authors have developed a technique for performing Le Fort III osteotomy using internal devices but without bicoronal incision. PATIENTS AND METHODS: The authors performed the Le Fort III distraction technique in 22 patients. Of these, 17 patients underwent an approach using conventional coronal incision; the others underwent an approach without coronal incision. This new approach was performed using a McCord incision, a brow incision, and gingivo-buccal sulcus incisions. We then performed osteotomy and attached the internal device. RESULTS: The age of patients ranged from 6 to 21 years (mean: 14.1 +/- 5.0 years) and 6 to 38 years (mean: 19.6 +/- 11.5 years) in the groups with or without coronal incision, respectively. Mean operative time was 410 +/- 196 minutes in the group with coronal incision and 357 +/- 121 minutes in the group without coronal incision. Mean blood loss (per unit of body weight) was 51.3 +/- 38.5 and 33.9 +/- 9.9 ml/kg) in the groups with or without coronal incision, respectively. There were no complications, except in the case of a 38-year-old patient, the oldest patient, who lost vision in the left eye after surgery. CONCLUSION: A direct facial approach for Le Fort III distraction was useful because of its reduced operative time and blood loss. However, down fracture following incomplete osteotomy or inadequate dissection of the orbit may cause blindness. Consequently, this technique requires careful attention.