Combined contraction and distraction of the facial skeleton in staged treatment of an atypical facial cleft using distraction devices

The purpose of this clinical report was to present a case of a rare Tessier 2/12 craniofacial cleft, which was treated by using mandibular distractors in a reverse manner for the reapproximation of the craniofacial skeleton allowing for closure of the soft tissue component and palate of this cleft. The changes in the bony portions of the cleft were accomplished without osteotomies taking advantage of the mobility of the facial bones involving both normal bony sutures and the cleft bone. The bone movement allowed for easier adhesion of the midline lower facial soft tissue during the first year of life. The outcomes were both functionally and aesthetically satisfactory. Although the ability of distractor devices to regenerate bone is well documented, they can also accomplish the same effect in a reverse manner. This new use of distraction devices in a reverse manner to contract the craniofacial skeleton without osteotomies to the author's knowledge has not been previously reported and adds a valuable tool to closing large facial clefts. However, considering the severity and complexity of the deformities, long-term follow-up will be necessary to assess the benefits of the surgical interventions and the patient's quality of life.