90-166-02-04_09_03_Marchac_Distraktor

Clinical Examples Case I

Pre-op view I

Pre-op view II

Lat x-ray view

Post-distr. view I

Post-distr. view II

AP x-ray view

Pre-op view I

Pre-op view II

Lat x-ray view

Post-distr. view I

Post-distr. view II

AP x-ray view

Case II

Recommended Instruments 1

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25-430-16 Centre-Drive screwdriver, 1.5 mm

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25-486-13 Modeling pliers (two are recommended)

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25-441-16 Plate holding forceps

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25-435-15 Lindorf plate holding forceps 1

51-500-90 Patient screwdriver (for temporal distractor) 1

51-525-85 Patient screwdriver (for cranial distractor)

25-471-07 Drill bits, 1.1 x 50 x 7 mm, cylindrical (5 each) alternatively: 25-452-07 Drill bits, 1.1 x 50 x 7 mm, Stryker attachment (5 each)

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1

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Recommended Screws 25-665-03 25-665-05 25-665-06 25-665-07 25-666-05

Centre-Drive® Titanium Micro Screws 1.5 x 3.5 mm (5 each) Centre-Drive® Titanium Micro Screws 1.5 x 5 mm (5 each) Centre-Drive® Titanium Micro Screws 1.5 x 6 mm (5 each) Centre-Drive® Titanium Micro Screws 1.5 x 7 mm (5 each) Centre-Drive® Titanium Micro Emergency Screws 1.8 x 5 mm (5 each)

International Partners in Oral, Plastic and Craniomaxillofacial Surgery 09.03 . 90-166-02 . Printed in Germany Copyright by Gebrüder Martin GmbH & Co. KG Alle Rechte vorbehalten.

Technische Änderungen vorbehalten.

We reserve the right to make alterations.

Cambios técnicos reservados.

Sous réserve de modifications techniques.

Ci riserviamo il diritto di modifiche tecniche.

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Distraction Osteogenesis

The Marchac-Arnaud Distraction System for fronto-orbital advancement

www.martin-med.com

The Marchac-Arnaud Distraction System Introduction

Indications

The treatment of faciocraniosynostoses pursues a double goal: prevention of functional impairment (brain, vision, airways), and morphological correction of the deformity (exorbitism, maxillary retrusion). While monobloc frontofacial advancement is by far the most satisfying craniofacial procedure because it allows the simultaneous correction of the frontal and facial retrusions, its mortality is high due to the large retrofrontal dead space created by the osteotomization (and subsequent full mobilization) of the anterior skull base and the critical connection between this dead space and the nasal fossae, even though additional measures might be able to reduce the infection risks. Therefore, we used this classical procedure only in extreme conditions and usually treated faciocraniosynostoses by way of a dual strategy, combining monobloc advancement with distraction. Preliminary reports have shown very satisfactory results for this gradual approach. We are going to present our initial experience with infants, using a double pair of distractors which allows parallel treatment in just one step.

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Cases in which a facial advancement (LeFort III) or a frontofacial (monobloc) advancement is necessary.

Both of these procedures are recommended for functional and respiratory reasons.

Contra-indications Poor general condition as a standard contra-indication to any major surgery; infection of the bones or scalp; immune deficiency.

This procedure is recommended only for experienced craniofacial teams including a plastic craniofacial surgeon and a neurosurgeon (monobloc procedure). It should also be mentioned that this device will not correct further growth lack, as naturally occurs in treated and untreated craniosynostosis.

Special notes Prior to implantation, a 3D-CT scan and/or the production of a stereolithographic model is advisable in order to define the optimal position and vector of the distractor and to check the thickness of the temporal bone.

Intra-operative approach

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51-620-25 Marchac-Arnaud temporal distr., baby, 25 mm 51-620-35 Marchac-Arnaud temporal distr., children, 35 mm

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Coronal incision, then undermine the temporal muscles and complete the LeFort-III osteotomy. Mobilize the face with Rowe forceps, then adapt the distractor(s), ensuring correct length of system components and selecting an appropriate Molina pivot for use behind the inferior part of the lateral zygoma at the junction with the zygomatic arch.

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51-630-20 Arnaud-Marchac cranial monobl. distr., 20 mm

Distraction protocol • Distraction of 0.5 or 1.0 mm per day in one or two sessions

Developed in cooperation with Prof. Dr. Daniel Marchac Dr. Eric Arnaud, Paris, France

• Latency time: 5 days • Stabilization/retention time: 3-6 months

Removal of the distractor

Ident number

Thanks to the flexible, easily adaptable mesh plates, the distractor can be attached to the temporal bone monocortically. This ensures easy access when the device is to be removed.

A stabilization/retention period of three months is necessary for LeFort III, and six months for the monobloc procedure. A limited bilateral incision is sufficient to remove the isolated temporal distractor in LeFort-III procedures.

In monobloc procedures, however, a coronal incision is mandatory.

On each label one will find an identification number.

In case of complaints please use the indicated numbers for traceability. It is advisable to attach the ident number to the the patient´s file.

Bending procedure To avoid mesh plate damage during the bending procedure, please use always two bending pliers ref. no. 25-486-13.

Literature/References • Polley JW, Figueroa AA, Charbel FT, "Monobloc craniomaxillofacial distraction in a newborn with severe craniofacial synostosis: a preliminary report”. J Craniofacial Surg. 1995, 6: 421-423

• Arnaud E, Marchac D, Renier D, "Double distraction interne avec avancement frontofacial précoce pour faciocraniosténose.

A propos de cinq cas cliniques”.

Ann Chir Past Esthet 2001, 46: 268-276

• Raposo de Amaral CM, Gradual bone distraction of the VII ISCFS. Santa Fe, NM, USA, 1997

• Arnaud E, Marchac D, Renier D, "Double internal distraction with monobloc advancement in infants”. Proc. III Int Congress on Distraction. Paris, 14-16 June 2001

• Cohen SR, Boydston W, Hudgins R, Burstein FD, Monobloc and facial bipartition distraction with internaldevices”.

J Craniofacial Surg. 1999, 10: 244-251

• Dogliotti P, Nadal E, Rodriguez JC, "Craniofacial distraction en bloc: A 3 year follow-up”.

Braz J Craniomaxillofac Surg. 2001, 4(1): 13-16

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Marchac Temp. Distractor Distractor for babies 25 mm 51-620-25 Distractor for children 35 mm 51-620-35

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to order separately: Pin for babies 40 mm Pin for babies 50 mm Pin for babies 60 mm Pin for babies 70 mm

51-621-40 51-621-50 51-621-60 51-621-70

Pin for children 50 mm Pin for children 60 mm Pin for children 70 mm Pin for children 80 mm

51-622-50 51-622-60 51-622-70 51-622-80

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Pivot fig. 1

51-605-01 A

B

Pivot fig. 2

51-605-02

Pivot fig. 3

51-605-03

Arnaud Cranial Distractor Distractor 20 mm

51-630-20 1

max. distraction length 51-621-40 Pin for babies, 40 mm 51-621-50 Pin for babies, 50 mm 51-621-60 Pin for babies, 60 mm 51-621-70 Pin for babies, 70 mm 51-622-50 Pin for children, 50 mm 51-622-60 Pin for children, 60 mm 51-622-70 Pin for children, 70 mm 51-622-80 Pin for children, 80 mm 51-605-01 Pivot, fig. 1 51-605-02 Pivot, fig. 2 51-605-03 Pivot, fig. 3

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51-620-25 Marchac-Arnaud temporal distr., babies 25 mm

51-620-35 Marchac-Arnaud temporal distr., children 35 mm

51-630-20 Arnaud-Marchac cranial monobl. distr.

20 mm

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X X X X X X X

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Note:

• A complete temporal distractor always comprises the

distractor itself (ref. no. 51-620-xx), an appropriate pin (ref. no. 51-621-xx or 51-622-xx, depending on the patient to be treated), and one pivot (these products have their own reference numbers, as mentioned above).

The cranial monobloc distractor (ref. no. 51-630-20) can be used optionally.

• The temporal distractors (ref. no. 51-520-25 and 35)

are activated with patient screwdriver no. 51-500-90 (0.5 mm per full turn/360°). For cranial monobloc distractor (ref. no. 51-630-20), the patient screwdriver no. 51-525-85 (0.3 mm per full turn) must be used.