Cranium and midface distraction osteogenesis: current practices, controversies, and future applications

Area of Science:

• Craniofacial surgery
• Pediatric plastic surgery
• Neurosurgery

Background:

• Distraction osteogenesis (DO) transformed craniofacial surgery by enabling gradual skeletal advancement, eliminating the need for bone grafts and allowing earlier treatment.
• DO is crucial for correcting exorbitism and respiratory issues in faciocraniosynostosis, though treatment approaches differ among surgical teams.

Purpose of the Study:

• To outline and discuss current practices, controversies, and future applications of distraction osteogenesis in craniofacial surgery.
• To present a specific treatment strategy for faciocraniosynostosis utilizing DO.

Main Methods:

• Early intervention (<18 months) including posterior vault decompression and distraction.
• Frontofacial monobloc advancement with DO around 18 months for brain decompression, respiratory function, and correction of exorbitism.
• Use of internal distractors for younger infants and external distractors for older children, sometimes in combination for severe cases.

Main Results:

• Early intervention prevents irreversible brain damage and improves craniofacial deformities.
• Frontofacial monobloc advancement with DO effectively decompresses the brain, enhances respiration, and corrects eye protrusion.
• Both internal and external distractors are utilized, with a preference for internal distractors in younger patients and external distractors for precise maxillary rotation in older children.

Conclusions:

• The choice between internal and external distractors, and single-stage versus two-stage approaches, remains debated.
• Multicenter prospective studies are essential to provide objective data and guide optimal treatment strategies for faciocraniosynostosis.