Simultaneous Lefort 2 Distraction and Fronto-Orbito-Malar Advancement: Correcting Severe Upper and Midface Retrusion in a Patient With Crouzon Syndrome

Craniofacial syndromes present with exorbitism and airway obstruction as a result of upper and middle facial hypoplasia. Classical subcranial Lefort III (LF III) or monobloc distraction osteogenesis (DO) using an external craniofacial device is used to treat these deformities. These procedures are done during mixed dentition, in most cases, advancing an abnormal face, to a more normal position. In patients with a severe midface retrusion, to achieve differential facial changes, Hopper and colleagues have proposed a combination of LF II distraction with simultaneous zigomatic repositioning. The aim of this presentation is to show a 3-year follow-up of a patient with Crouzon syndrome with severe upper and midface retrusion, who underwent an LF II DO combined with a fronto-malar advancement to achieve cranial and midface expansion and facial ratio normalization. The authors present a variation of technique by Hopper and colleagues;​ a combined intra and extracranial procedure, performing simultaneously a fronto-orbital-malar advancement and LF II DO. The authors performed photographs and craniofacial computed tomography scans to evaluate the patient's appearance and shape of the cranial base. Authors found an important expansion of the middle third of the face with improved facial rations due to differential movement of the bony segments. Lefort II distraction in combination with fronto-orbito-malar advancement is an excellent option for the treatment of patients with severe upper and middle face retrusion. It provides eye globe protection enabling maximal midfacial expansion, resulting in a better functional and esthetic outcome. Results have remained stable after 3 years.