Unanticipated Fractures of the Zygomatic-Maxillary Suture in LeFort III Internal Distraction: Salvage of Midfacial Advancement via Rigid External Distraction of an Orphaned LeFort II Segment

Abstract

Currently, the most common approach for treating midface hypoplasia in syndromic craniosynostoses patients is the LeFort III with distraction osteogenesis. Distraction osteogenesis can be performed through either internal or external distraction systems. Each modality offers unique advantages and disadvantages. A rare complication associated with internal distraction is fracture of the zygomatic-maxillary suture caused by distraction forces on this area. This complication has been reported in patients with Pfeiffer and Apert syndromes, related to convexity of temporal bones increasing force on the zygomatic-maxillary suture. In the current report, we present the first case in the literature of an internal distraction associated zygomatic-maxillary fracture in a patient with Crouzon syndrome. We also present a subunit osteotomy salvage approach. Through mobilization of a LeFort II segment and rigid external distraction to advance orphaned segments of the midface, a favorable aesthetic result was salvaged from this complication.