Tuesday, May 31, 2016

Ask the Doctor: Midface in His 20s?

CCA posts a monthly blog series called, "Ask the Doctor." You can submit your questions to Annie Reeves ([email protected]) and we will ask Dr. Earl Gage of Kids' Plastic Surgery in St. Louis to answer them. Thanks Dr. Gage for helping spread information and resources for our cranio families!

Ask the Doctor

Earl Gage, MD

Question: My 23 year old son has severe type 2 Pfeiffer syndrome. He had the midface surgery using his ribs at age 6 with good results, but with time, his midface has become more retracted and his orbits bulge. We were planning another midface at age 19, but due to many other medical problems, it didn't happen. What are the options for a midface surgery at his age? I was told in the past not a candidate for the RED device since he is done growing.

Answer:  The decision to use distraction or not has a lot more to do with the degree of movement that your son requires to get his midface where it needs to be rather than his age. Distraction can be done at any age. While it is perhaps true that adults may not make bone as readily or as quickly as children, a young man at age 23 should still be able to heal well using distraction.

Midface distraction, as you likely already know, involves making cuts in the bone to “free up” the midface so it is no longer attached to the skull. Then, the distractor is used to pull the midface bones forward slowly over time. The goal is to move the face forward slowly enough that bone healing “keeps up” with the moving midface but not so slowly that the bone heals solidly before you get the bones where they need to be. The pace of movement can be anywhwere from 1-3mm per day, depending on a variety of factors.

The advantage of midface distraction is that a much larger advancement can usually be achieved with this technique than with non-distraction techniques that require you to make the full advancement at the time of surgery. When someone has had previous surgery, such as your son, and where a large advancement may be required, scar tissue and the tightness of the soft tissue of the face may limit how much movement you can achieve with traditional surgery. Because distraction gradually stretches the soft tissue, the limitations of scar and soft tissue tightness can often be overcome with distraction.

In summary, it is my opinion that your son’s age should not automatically disqualify him from midface distraction surgery. In fact, depending on how much advancement he needs, distraction may be the best option to achieve the advancement he needs and provide a stable, long term result. I encourage you to discuss this option again with your surgeon so that your son’s overall health and his specific needs may be taken into account as you make a final decision on how to proceed. Best of luck!

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