From midface distraction to the "true monoblock"

In treating craniosynostosis, during the past 2 decades it has become accepted practice to perform fronto-orbital advancement and delay midfacial surgery. Corneal exposure,associated airway difficulties, and psychosocial problems remained untreated in these patients. Distraction osteogenesis assisted endoscopically offers an alternative treatment for patients with craniosynostosis, with the possibility of early midfacial surgery and simultaneous correction of the orbital-frontal deformity. The major benefit of gradual distraction is that it allows the surgeon to overcome the resistance of the overlying soft tissue envelope and offers the option of displacing the skeletal framework over greater distances, thus avoiding bone grafting. The technique also reduces morbidity and produces an improvement in form and function.