Gradual bone distraction in craniosynostosis. Preliminary results in seven cases

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Pediatric Neurosurgery

Background:

• Craniosynostosis involves premature fusion of skull sutures, leading to abnormal head shape and facial deformities.
• Apert syndrome and Crouzon's disease are common syndromic forms of craniosynostosis requiring surgical intervention.
• Traditional surgical methods may involve multiple stages and bone grafting, with associated complications.

Purpose of the Study:

• To evaluate the efficacy of gradual bone distraction for skull lengthening in pediatric craniosynostosis.
• To compare outcomes between coronal craniectomy with distraction and monobloc craniofacial disjunction with distraction.
• To assess the functional and aesthetic improvements in the midface and correction of exophthalmos.

Main Methods:

• Seven patients with craniosynostosis (Apert, Crouzon syndromes) underwent gradual bone distraction for skull lengthening.
• Group A (n=3): Coronal craniectomy extending to the orbital fissure followed by distraction.
• Group B (n=4): Monobloc craniofacial disjunction followed by distraction.

Main Results:

• Monobloc craniofacial disjunction with gradual bone distraction (Group B) achieved complete correction of exophthalmos.
• Significant improvements in the functional and aesthetic aspects of the midface were observed in Group B.
• No bone grafts were required in either treatment group.

Conclusions:

• Gradual bone distraction, particularly via monobloc craniofacial disjunction, is an effective technique for treating craniosynostosis.
• This approach offers substantial aesthetic and functional benefits, including correction of proptosis.
• The technique avoids the need for bone grafting, simplifying the surgical process and potentially reducing complications.