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Case report
Unique mishap following transfacial pin fixated midface distraction and successful management using nasal endoscopy
  1. Naveenkumar Jayakumar1,
  2. Thirunavukarasu Saravanamuthu2,
  3. Chidambaram Balasubramaniam3 and
  4. Ramesh Singaravelu4
  1. 1Oral and Maxillofacial Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
  2. 2Paediatric Otolaryngology, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India
  3. 3Paediatric Neurosurgery, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India
  4. 4Anesthesia, Kanchi Kamakoti Childs Trust Hospital, Nungambakkam, Tamil Nadu, India
  1. Correspondence to Professor Naveenkumar Jayakumar; naveenkumarj{at}


A 2-year-old female child with craniosynostosis was referred to our unit for definitive management. She presented with a turricephalic head, hypoplastic midface and obstructive sleep apnoea. Routine preoperative workup included radiographs, CT and polysomnography. She was provisionally planned for calvarial remodelling and midface advancement using transfacial pin fixated distractor (TPF). This involves insertion of a K-wire from one zygoma to the other, a few millimetres below the orbits, traversing across maxilla and nasal cavity. The ends of K-wire are then connected to the distractor anchored firmly to the temporal bone. During insertion, the K-wire transected the nasogastric tube. This technical disaster was circumvented by endoscopic-guided disengagement prior to recovery. The purpose of this paper is to discuss the probable causes that lead to such untoward instances and strategies to avoid and manage the same.

  • eye
  • paediatric intensive care
  • sleep disorders (respiratory medicine)
  • oral and maxillofacial surgery
  • otolaryngology / ENT
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  • Contributors NKJ: corresponding/primary author and primary surgeon. BC: neurosurgeon involved in surgery (preparation of manuscript and photographs). TS: otolaryngologist identifed and removed Ryle’s tube (videographs preparation). RS: paediatric anaesthesiologist (preparation of manuscript).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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