Management of Midface Deficiency in Syndromic Craniosynostosis with Lefort III Distraction Osteogenesis, Outcomes, and Pitfalls

Vidya Rattan; Ramesh Kumar Sharma; Akshat Gupta; Satinder Pal Singh; Apoorva Singh; Satnam Singh Jolly

doi:10.1007/s12663-024-02202-8

Management of Midface Deficiency in Syndromic Craniosynostosis with Lefort III Distraction Osteogenesis, Outcomes, and Pitfalls

J Maxillofac Oral Surg. 2024 Dec;23(6):1355-1365. doi: 10.1007/s12663-024-02202-8. Epub 2024 May 24.

Authors

Vidya Rattan¹, Ramesh Kumar Sharma², Akshat Gupta³, Satinder Pal Singh⁴, Apoorva Singh¹, Satnam Singh Jolly¹

Affiliations

¹ 104, Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, 160012 India.
² Plastic and Reconstructive Surgery, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, 160012 India.
³ Department of Oral and Maxillofacial Surgery, Daswani Dental College, Kota, India.
⁴ Unit of Orthodontics and Dentofacial Deformities, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, 160012 India.

PMID: 39618452
PMCID: PMC11607258 (available on 2025-12-01)
DOI: 10.1007/s12663-024-02202-8

Abstract

Background: Syndromic craniosynostosis is characterized by premature fusion of cranial sutures resulting in midface deficiency. Lefort III Distraction Osteogenesis (DO) has emerged as an effective surgical intervention for addressing this complex condition. This case series outlines the outcomes, encountered difficulties, and insights gained through the utilization of Lefort III Distraction Osteogenesis (DO). Six patients (age range: 8-18 years) diagnosed with syndromic craniosynostosis underwent Lefort III DO for midface deficiency correction.

Methods: Comprehensive preoperative orthodontic preparation and meticulous surgical planning were executed. The present paper highlighted the promising outcomes with Lefort III DO, such as significant advancements in midface projection, enhanced posterior pharyngeal space, improved ocular position, and the establishment of functional occlusion.

Results: However, some complications such as CSF blepharocele, pin-tract infection, cranial pin perforation, and loosening of the halo frame were encountered. These challenges were addressed with prompt intervention and close postoperative monitoring. Lefort III DO emerges as a valuable approach in effectively addressing midface deficiency in syndromic craniosynostosis patients. While yielding favorable outcomes in terms of facial aesthetics and function, it requires meticulous surgical technique and vigilant postoperative care to address potential complications.

Conclusion: This paper contributes insights into the effective management and potential challenges associated with Lefort III DO in treating midface deficiency in syndromic craniosynostosis patients.

Keywords: Complications; Distraction osteogenesis; Lefort III; Midface advancement; Subcranial; Syndromic craniosynostosis.

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