Cranial expansion with distraction osteogenesis for multiple-suture synostosis in school-aged children

Multiple-suture synostosis is a rare condition among patients with craniosynostosis. Their cranial shapes demonstrate various types depending on the fused sutures, and it tends to be less consistent in comparison to single-suture synostosis. The details regarding surgical intervention for multiple-suture synostosis have rarely been documented. This report presents 4 patients with nonsyndromic multiple-suture synostosis who were incidentally diagnosed as school-aged children. The age at the time of the surgery ranged from 7 to 11 years. All of the patients demonstrated digital printings on radiographs and an increased intracranial pressure. They underwent cranial expansion using the technique of distraction osteogenesis. In 3 patients, a pi osteotomy was performed; however, the osteotomized bone was not detached from the underlying dura. Four distraction devices were applied. In one patient, an occipital osteotomy was performed, and 2 distraction devices were applied. Distraction was completed in all patients, and the results of surgery were satisfactory. Large bony gaps are generally created by the conventional course of skull expansion. In older children, the bone defects are optimally treated by bone grafts. To harvest bone grafts, it is preferable to split the cranial bone. In this series, however, the calvarial bones were so thin that they could not be split. Therefore, the technique of distraction osteogenesis was used. Cranial distraction is a reliable and less invasive modality. In addition, it can allow for skull expansion without bone grafting in school-aged children.