This is an analysis of the long term follow-up of 20 patients with syndromic midface hypoplasia who underwent Le Fort III osteotomy with internal distraction since 1994.

Our distraction protocol calls for immediate distraction postoperatively with no latency period, an accelerated, maximal rate of distraction performed for less than one week, internalized distraction hardware to diminish facial scarring and to allow for a longer period of bony consolidation, and performance of a full-thickness osteotomy without preservation of native periosteum.

We have found reduction or elimination of obstructive sleep apnea in all craniofacial dysostosis patients treated with midface distraction. We attribute this to the greater amount of advancement (avg. 20 mm) achieved compared with the traditional rigid fixation techniques. In addition, the midfacial advancement achieved has remained stable with time and all patients acquired substantial improvement in appearance. Serious complications have not been encountered and minor complications include nasal lengthening and mild malpositioning at the orbital level. We feel that our technique of Le Fort III osteotomy with immediate internal distraction adds little morbidity with the potential for significant improvement in the results. The internal, submergible feature of our device design offers advantages in patient acceptance, fixation stability, and wound management.