Management of Middle Third Hypoplasia Using Rigid External Device: Long-Term Analysis of Results and Report of Complications

Objective: The objective of this study was to review and present the experience, with the functional results as well as complications of the individuals who underwent facial middle-third advancement with rigid external device. We report a major complication (cerebral abscess) secondary to pin migration. Background: There are functional and esthetics objectives when performing surgical procedures in middle facial third hypoplasia. Many have compared external and internal distraction devices use and results with a lack of evidence on perioperative morbidity; this study was designed to revise complications associated with external distraction. Methods: This retrospective study was conducted over a 5-year period, including 24 patients. Patient’s characteristics, perioperative factors, and postoperative complications were revised. Results: Twenty-four patients undergoing midfacial/fronto-orbital surgery, between 2020 and 2024 were included (Crouzon, Apert, and Kabuki syndromes, cleft lip and palate sequelae, and craniosynostosis cases). The mean follow-up was 39.5 months (±15.98 mo). Monobloc advancement was the most frequently performed procedure (45.8%), followed by Lefort-III (37.5%), Lefort-II (12.5%), and fronto-orbital advancement (8.3%). The mean advancement achieved was 18.9 mm (±6.06 mm). Of the total, 58.33% had no complications, with 37.5% and 4.16% having grade II and grade III-B complications (Clavien-Dindo System). The patient from the case report, had a cerebral abscess, whose course required the removal of the external device, getting a 6.7 mm advancement. Conclusions: Distraction osteogenesis remains a great procedure where significant midfacial advancement is required, despite the complication rate. There should be a well-defined preoperative and postoperative protocol to avoid major complications from happening.