Frontofacial Monobloc Advancement With Internal Distraction: Surgical Technique and Osteotomy Guide

• Published in: Operative neurosurgery (Hagerstown, Md.) Vol. 23; no. 1; pp. e33 - e41
• Main Authors: Ferreira Junior, Tancredo Alcântara, Fontoura, Renato Rinco, Marques do Nascimento, Leyzeane, Alcântara, Mariana Torres, Capuchinho-Júnior, Geraldo Andrade, Alonso, Nivaldo, Matushita, Hamilton, Costa, Bruno Silva, Faraj de Lima, Franklin Bernardes
• Format: Journal Article
• Language: English
• Published: United States 01-07-2022
• ISSN: 2332-4252; 2332-4260
• DOI: 10.1227/ons.0000000000000167

Craniosynostosis are cranial deformities resulting from the early closure of 1 or more sutures. Concomitant facial changes are complex and usually result from the involvement of multiple sutures, which may lead to restriction of cranial growth and brain expansion, ocular compression, and breathing difficulties. Surgical techniques to correct syndromic craniosynostosis have improved over time, considerably reducing the rate of complications of this procedure.
To describe in detail (step-by-step) and with pertinent anatomic considerations the technique of monobloc frontofacial advancement using internal distractors.
We describe the monobloc frontofacial advancement technique with the use of internal distractors, which we use in patients with primary syndromic craniosynostosis (Apert, Crouzon, and Pfeiffer) who have major facial hypoplasia and secondary respiratory repercussions. To illustrate this technique, the procedure was performed in 2 cranial models: an adult artificial acrylic skull of normal morphology for better evidence of anatomic repairs and a 3-dimensional printed infant skull from a tomography file obtained from a child diagnosed with Apert syndrome.
The benefits of osteogenic distraction and better surgical timing for each procedure are presented. We presented the changes and details of osteotomies performed during the procedure, as well as anatomic details and care regarding the pterygomaxillary dysjunction.
Monobloc frontofacial distraction is a procedure with widely demonstrated aesthetic and functional results, and this detailed step-by-step description may improve familiarity with the anatomic landmarks of the procedure and provide a better dynamic understanding of the distraction process.