Serious Complications After Le Fort III Distraction Osteogenesis in Syndromic Craniosynostosis: Evolution of Preventive and Therapeutic Strategies

Background: There is a paucity of studies that report complication rates following a subcranial Le Fort III advancement using distraction osteogenesis. The purpose of this study was to identify and describe serious postoperative complications following Le Fort III advancement with distraction osteogenesis, and provide strategies to assist in the resolution of these complications. Methods: An observational retrospective study was performed on consecutive patients with Apert, Crouzon, or Pfeiffer syndromes (n = 16) who underwent Le Fort III advancement using distraction osteogenesis between 2008 and 2017. Serious complications were defined as frontal bone loss, cerebrospinal fluid leak, meningitis, seizures, or major blood loss (ie, massive transfusion within the first postoperative day). Results: Three (18.7%) patients presented serious complications, namely cerebrospinal fluid leak (n = 1; 6.2%), seizures (n = 1; 6.2%) due to a halo-type device trans-pin intracranial migration, and major blood loss (n = 1; 6.2%). Adopting well-delineated interventions, all of these complications were resolved without fatality. Conclusion: A Le Fort III advancement has a significant morbidity rate, with 3 of our patients (18.7%) in this study presenting serious complications. Appropriate management reduced this morbidity, and all complications were resolved without fatality.

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