Retrospective review of the complication profile associated with 71 subcranial and transcranial midface distraction procedures at a single institution

Background/Purpose: Patients with syndromic craniosynostosis and midface hypoplasia often undergo midface advancement to improve respiratory function, orbital relationships, and facial appearance. This study characterizes the perioperative morbidity of a large cohort of subjects who underwent transcranial or subcranial midface distraction. Methods: Demographic and perioperative data were compared between those who underwent transcranial or subcranial midface DO between July 1999 and December 2017. Univariate analysis was conducted using chi-square and Fisher exact tests for categorical variables, and Mann-Whitney U test for continuous variables. Multivariate analysis was conducted using logistic regression modeling. Complications were graded using the Clavien-Dindo classification. Results: Sixty-four subjects (34 female, 30 male) underwent a total of 71 midface distraction procedures. There was a total of 28 (39%) complications. The transcranial cohort had a significantly higher frequency of complications (58%) compared to the subcranial cohort (29%, p=0.017), with a significantly greater proportion of infection-related complications in the transcranial cohort (80% vs 54%, p=0.028). Transcranial complications included cranial contamination, whereas most subcranial cohort infections were superficial or limited facial abscesses. The only significant predictor variable for complications in a multivariate analysis was whether the osteotomy approach was transcranial as opposed to subcranial, with an odds ratio of 5.80 (p=0.013). Conclusion: Complication rates in midface distraction remain high, with transcranial procedures having significantly higher complication rates, infection-related complications, and notably greater severity of complications. While the goals of surgery often dictate choice of osteotomy, thorough understanding of the risks associated with transcranial procedures must be understood by surgeon and patient alike. Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Conflicts of Interest: The authors report no relevant financial disclosures related to this current work. IRB: This study has been approved by the Institutional Review Board for research involving human subjects at the Children's Hospital of Philadelphia. Corresponding Author: Dr. Jesse A. Taylor, Department of Surgery, The Children's Hospital of Philadelphia, The University of Pennsylvania, Colket Translational Research Building, 9th Floor, Philadelphia, PA 19104; Telephone: 215-590-2208, Fax: 215-349-5895, E-mail: taylorj5@email.chop.edu ©2018American Society of Plastic Surgeons

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