Internal Distraction Resulted in Improved Patient Reported Outcomes for Midface Hypoplasia
David Hindin, MD1, Corbin E. Muetterties, BS1, Justine C. Lee, MD, PhD2, Anand Kumar, MD3, Henry K. Kawamoto, MD, DDS2, James P. Bradley, MD1.
1Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA, 2David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, 3Johns Hopkins School of Medicine, Baltimore, MD, USA.
Background: Both internal and external distraction devices have been used successfully in correcting midface hypoplasia. Although the indication for surgery and the osteotomy techniques for a Le Fort I and Le Fort III may be similar, deciding when to use an internal vs external device has not been well studied. We studied patient reported outcomes using the FACE Q Patient Reported Outcomes Instrument and functional surveys for internal and external devices for both Le Fort I and Le Fort III patients.
Methods: Midface hypoplasia patients who underwent distraction advancement after Le Fort I and Le Fort III were surveyed using the FACE-Q survey and a functional survey. Equal groups of internal and external device patients were compared (n=64). Data recorded included: Sex, age, follow-up, diagnosis, OR time, EBL, Length of stay, distraction length, consolidation time, and complications. FACE Q scales included: Satisfaction with Facial Appearance, Social Function (confidence), Psychological Well-being, Early life impact (recovery), and Satisfaction with Outcome and Decision. Functional surveys included Airway/Breathing (correction of sleep apnea, removal of tracheostomy), Ocular/Vision (globes protection), Occlusion/Eating, and Speech/Articulation.
Results: Internal and external device groups were similar with regards to patient demographics (Craniofacial diagnosis, mean age (14.4 years), sex, follow-up), operative time, EBL, distraction length (24.2 vs 25.1), and follow-up. Consolidation times differed (Internal=1.1 vs External=3.6 months). For FACE Q appearance appraisal (Overall Appearance, Cheeks, Nose, Upper lip/Smile), there were similarities in domain and scale. For Functional surveys (Airway/Breathing, Ocular Vision, Occlusion/Eating,
Speech/Articulation), there were also similar scoring between groups. However, internal device patients had superior scores compared to external devices with FACE Q for Quality of Life including: Social Function (80.9 ± 19 vs 68.9 ± 18), Early Life Impact (92.9 ± 22 vs 62.4 ± 11), Dental anxiety (70.2 ± 17 vs 48.3 ± 10), and Psychological Well-being (87.8 ± 18 vs 68.6 ± 11). (Figure 1) In addition, internal device patients were better with FACE Q Satisfaction Decision (81.2 ± 19 vs 56.9 ± 10) and Satisfaction Outcome (91.0 ± 22 vs 84.7 ± 18). (Figure 2)
Conclusions: Le Fort I and Le Fort III distraction patients had similar patient reported outcomes for appearance and functional improvement while using internal or external devices; however, those with internal devices were more satisfied with their quality of life and decision to undergo the procedure.
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