Intracranial fixation pin migration: a complication of external Le Fort III distraction osteogenesis in Apert syndrome.

External distraction osteogenesis has long been used in treatment of congenital midface hypoplasia. Distraction osteogenesis is associated with lower relapse rate and less complications compared with standard Le Fort III osteotomy. General complications in using rigid external distraction include localized infection, loosening of pins, and pin displacement. A 24-year-old female patient with Apert syndrome who underwent Le Fort III distraction osteogenesis is reported. Standard Le Fort III osteotomy was performed, and external distractor was placed. After 7-day latency period, the distractor was activated at the rate of 1 mm/d and finished after 20 days. A mild localized infection was recognized at the eighth week of consolidation period, and debridement was carried out at the left side of pin fixation. Obvious displacement of distractor occurred 1 week later while the patient was sleeping, and emergency operation was performed to remove the distractor and depress the left temporal skull bone fracture after clinical evaluation. The patient was asymptomatic clinically, and the advancement of the midface was stable. Le Fort I osteotomy was performed 3 years later to obtain a normal occlusion, and the patient was satisfied with the final outcome. We concluded that an unwanted trauma might cause severe complications such as skull bone fracture secondary to related local infection, and close follow-up and management are necessary for those cases.