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Unilateral coronal synostosis treated by internal forehead distraction
S Kobayashi1, T Honda, A Saitoh
1Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan.
Insights
This study demonstrates successful treatment of infant hemicoronal synostosis using internal distraction osteogenesis. The craniofacial distraction procedure achieved satisfactory cosmetic results and symmetry without complications.
Area of Science:
- Craniofacial surgery
- Pediatric neurosurgery
- Orthognathic surgery
Background:
- Hemicoronal synostosis in infants can lead to significant cosmetic and functional deformities.
- Traditional surgical correction methods may involve extensive dissection and potential complications.
- Distraction osteogenesis offers a minimally invasive approach to craniofacial reconstruction.
Observation:
- A 1-year-old infant with left hemicoronal synostosis underwent surgical correction.
- An internal distraction device was utilized for craniofacial distraction osteogenesis.
- The procedure involved osteotomy of the frontal bone and orbits, followed by gradual distraction.
Findings:
- A distraction rate of 0.5 mm/day achieved 17 mm of elongation.
- Satisfactory symmetry of the forehead, orbit, and nose was achieved post-operatively.
- The procedure resulted in no extradural dead space, reduced operative time, and minimal blood loss.
Implications:
- Internal distraction osteogenesis is a safe and effective treatment for infant hemicoronal synostosis.
- This technique offers improved cosmetic outcomes and fewer complications compared to traditional methods.
- Further research can explore long-term outcomes and broader applications in pediatric craniofacial surgery.
Abstract:
A 1-year-old infant with left hemicoronal synostosis was treated by distraction osteogenesis of the craniofacial skeleton using an internal distraction device. Surgery was performed through a coronal incision. The frontal bone and upper half of both orbits were first osteotomized en bloc after minimal epidural dissection of the supraorbital area and no epidural dissection around the coronal osteotomy site. The lateral one fourth of the frontal bone, including the right lateral half of the orbit, was left intact. The internal distraction device was fixed in the left temporal area. A 0.5-mm per day rate of distraction was performed up to an elongation of 17 mm after a 5-day latency period. The distraction device was removed after a consolidation period of 2 months. The results obtained were satisfactory, with symmetry of the forehead, orbit, and nose achieved without complications. The merits of this procedure are no extradural dead space after the operation (which prevents infection), shortened operative time, reduced blood loss, filling in the bone gap created by advancement with new bone, acceptable cosmesis by the parents during distraction, and no fixation device left after the second operation.