Case Report of Osteomyelitis after Monobloc Advancement for the Treatment of a Crouzon's Syndrome

Baek, Rong Min; Kim, Myung Good; Han, Sang Baek

Abstract

In 1912, Crouzon described a syndrome compromising the triad of cranial deformity, facial deformity, and exorbitism. Crouzon's syndrome occurs in 1 in 25,000 live births and follows an autosomal dominant mode of transmission. However 30 to 60% of cases are sporadic and represent fresh mutations. The 27-year-old female patient we report here has family history of two cases of Crouzon's syndrome. The patient had mild nasal obstruction and rhinorrhea, which didn't make the surgery absolutely contraindicated. The Monobloc advancement-Le Fort III osteotomy for midfacial advancement and the lamellar split osteotomy of supraobital bandeau for orbitofrontal advancement- were performed. After 8~12 weeks of patient follow up, CSF rhinorrhea was observed and infection was suspected. The primary focus of infection was supposed to be preexisting sinusitis of the patient. The infection didn't spread intracranially, which was contributed by intact inner table of cranium owing to the lamellar split osteotomy. In conclusion, 1) The importance of irradication of preexisting nasal / perinasal infection such as sinusitis cannot be emphasized too much, 2) How to obliterate the dead space between the inner and outer table, and 3) In terms of infection, at least, lamellar split osteotomy can be regarded superior to classical osteotomy, since inner table serves as a barrier of ascending infection.