Distraction in anterior plagiocephaly: technique, risks, and long-term results

The purpose of this study is to define the perioperative outcomes and long-term aesthetic outcomes of patients with unicoronal craniosynostosis (UCS) treated with fronto-orbital distraction osteogenesis (FODO) and compare them to a contemporaneous cohort treated with conventional fronto-orbital advancement and remodeling (FOAR).

A retrospective review was performed for all patients treated at the Children's Hospital of Philadelphia for non-syndromic UCS from 2009-2025. Demographic and perioperative data were collected. Preoperative and 5-year or greater postoperative frontal 2D photographs were used to assess for facial, and specifically periorbital, symmetry. Symmetry ratios were calculated to assess periorbital facial morphometry.

Sixty-two patients were included in the study, 34 FODO, and 28 FOAR. FODO demonstrated significantly shorter anesthesia and surgical times, lower estimated blood loss, and shorter length of stay (all p < 0.001). The overall complication rate was similar (p = 0.175), but postoperative infection was more commonly reported in the FODO group (24 vs 1%, p = 0.033). Thirty-two patients had a 5-year or greater postoperative photographs, 16 FODO, and 16 FOAR. Patients in the FODO group were found to have greater improvements in palpebral width symmetry (0.32 vs -3.4, p = 0.039) and canthal tilt symmetry (1.51 vs -1.20 degrees, p = 0.035). One patient in the FOAR group required reoperation due to signs of elevated ICP.

FODO results in improved perioperative and long-term aesthetic outcomes compared to FOAR, resulting in improved canthal tilt and palpebral width symmetry. Future studies should focus on severity-matched analyses.