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Primary grafting with autologous cranial particulate bone prevents osseous defects following fronto-orbital
Arin K Greene1, John B Mulliken, Mark R Proctor
1Boston, Mass. From the Craniofacial Center and Department of Plastic Surgery, Children's Hospital Boston, Harvard Medical School.
Insights
Corticocancellous bone grafting during fronto-orbital advancement significantly reduces cranial defects and the need for cranioplasty. This technique improves outcomes for children undergoing surgery for craniosynostosis.
Area of Science:
- Neurosurgery
- Pediatric Plastic Surgery
- Craniofacial Surgery
Background:
- Fronto-orbital advancement (FOA) for craniosynostosis can lead to cranial defects requiring cranioplasty in up to 20% of patients.
- Incomplete ossification of the frontal bone is a common complication after FOA.
- The study investigates a method to prevent these defects during the primary surgery.
Purpose of the Study:
- To evaluate the efficacy of using corticocancellous cranial particulate bone grafting during FOA.
- To determine if this technique reduces the frequency of incomplete ossification and subsequent need for cranioplasty.
- To assess the impact of this bone grafting on patient outcomes.
Main Methods:
- Retrospective analysis of 213 children who underwent FOA for craniosynostosis (1988-2006).
- Group I: Spontaneous healing of cranial gaps. Group II: Filling calvarial defects with corticocancellous particulate bone harvested from the endocortex.
- Outcome variables included persistent osseous defects and need for corrective cranioplasty.
Main Results:
- Group II (bone graft) had significantly fewer residual defects (5.5% vs. 24%) and required cranioplasty less often (3.1% vs. 20%) compared to Group I (spontaneous healing).
- These positive outcomes were observed despite Group II patients being older at the time of FOA.
- Statistical analysis confirmed the significance of these findings (p < 0.001).
Conclusions:
- Corticocancellous cranial particulate bone grafting is an effective method to reduce osseous defects after FOA.
- This technique decreases the need for secondary cranioplasty.
- The benefits of bone grafting are independent of patient age at the time of surgery.
Background:
Approximately 20 percent of patients require cranioplasty for defects after fronto-orbital advancement. The authors hypothesized that corticocancellous cranial particulate bone placed over exposed dura at the time of fronto-orbital advancement would decrease the frequency of incomplete ossification.
Methods:
The authors retrospectively analyzed consecutive children who underwent fronto-orbital advancement for craniosynostosis between 1988 and 2006. In group I, cranial gaps resulting from frontal advancement were left open and allowed to heal spontaneously. In group II, corticocancellous particulate bone was used to fill the calvarial defects. Bone was harvested from the endocortex of the frontal segments or parietal calvaria using a hand-driven brace and bit. Outcome variables were persistent osseous defects and need for corrective cranioplasty.
Results:
The study included 213 children. There were 50 patients in group I: mean age at fronto-orbital advancement was 7.0 months (range, 2 to 15 months); 12 patients (24 percent) had residual defects and 10 (20 percent) required cranioplasty. Group II contained 163 patients: mean age at fronto-orbital advancement was 14.1 months (range, 6 to 72 months); nine children (5.5 percent) had a cranial defect and five (3.1 percent) required cranioplasty. Infants in group II were less likely to have bony defects (p = 0.0005) or require cranioplasty (p = 0.0002) compared with children in group I, despite being older at the time of fronto-orbital advancement (p = 0.001).
Conclusion:
Corticocancellous cranial particulate bone grafting during fronto-orbital advancement reduces the prevalence of osseous defects and the need for secondary cranioplasty, independent of patient age.
