No abstract

Eleven patients with syndromic craniosynostosis were treated with gradual distraction fronto-orbital advancement using "floating forehead." The frontal and supraorbital area was cut and remolded. Bony orbits were widened in three patients. Frontal bone was let floating on the dura and fixed loosely with absorbable threads to remolded supraorbital bone. A pair of distracters with hinge plates (A.V.D. system, Bear Medic Corp, Tokyo, Japan) was fixed between the temporal area and supraorbital bone. Distraction was begun 5 to 7 days after the surgery, and 1.8 to 3.2 cm advancement was obtained. Distracters were taken off after 3 to 7 weeks of consolidation periods. Although no major complication was encountered, some minor complications related to the devices were experienced.

Fronto-facial monobloc advancement is one of the most rewarding procedures for upper and mid-face reconstruction in patients with craniosynostosis. However, it has challenging aspects. Epidural abscess and frontal bone necrosis after retrofrontal dead space is one of the major complications and has led many experienced surgeons not to continue with the procedure. Bone distraction can play a great role in preventing these problems. The Rigid External Distraction (RED-II) system is a external distraction device using the cranium as an anchorage point. In two craniosynostosis cases, fronto-facial monobloc advancement with the system was performed. Controllability of the monobloc segment increased significantly. Operative time and blood loss were lessened. No major complications were experienced.