Minimizing pin complications when using the rigid external distraction (RED) system for midface distraction

In this review we describe the advantages, complications, and preventive considerations encountered as a result of the use of a halo for distraction of a retrusive nasomaxillary complex. Distraction osteogenesis is a well accepted combined orthodontic-surgical technique used in the treatment of patients with hypoplastic craniofacial components. The rigid external distraction (RED) system is a useful external distraction device for the advancement of severe retrusive maxilla especially in cleft palate patients. However, the addition of this new technique to the surgeon’s armamentarium is accompanied by new complications and risks. Review of the literature on complications of the use of halo revealed that most complications are pin related. Complications with the use of RED have mainly included the penetration of intracranial pins. Risk management and preventive considerations propose several procedures to minimize the side effects when using RED: preoperative skull computerized tomography, pediatric neurosurgical consultation, proper pin care during distraction, frequent monitoring of the patient’s general condition, proper pin and torque design, and special attention to the removal process of the RED.