Virtual surgical planning in frontofacial advancement using a customized RED II distractor in children with syndromic craniosynostosis and midfacial hypoplasia

Syndromic craniosynostosis is frequently associated with severe midfacial hypoplasia, resulting in functional impairment such as elevated intracranial pressure, airway obstruction, and exorbitism. Frontofacial advancement is a complex and technically demanding procedure in a pediatric population. This study evaluates a structured approach combining VSP (Virtual surgical planning) with a customized RED II distractor. A retrospective analysis of patients with syndromic craniosynostosis treated between 2022 and 2026 at Charité - Universitätsmedizin Berlin was performed. Eight Patients were included who underwent CAD/CAM-based bi-bloc frontofacial advancement using a RED II distractor and patient-specific fixation plates. Surgical accuracy was assessed by comparing preoperative planning with postoperative CT data. Mean operative time was 484.9 ± 84.2 min, and hospital stay averaged 13.9 ± 6.6 days. Tracheostomy dependency decreased from 50% to 25%. Mean deviations ranged from 1.58 to 1.73 mm for frontal and 1.15-1.30 mm for maxillary segments. All patients showed functional and aesthetic improvement, including reduced exorbitism, improved airway status, and correction of malocclusion. No major complications occurred. VSP combined with a customized external distraction system enables accurate planning and reliable transfer of complex movements. Patient-specific implants optimize fixation in the context of limited bone thickness and developing dentition, improving surgical safety and workflow.