Distraction Osteogenesis for Unicoronal Craniosynostosis: Rotational Flap Technique and Case Series

Brandel, Michael G.; Ore, Cecilia L Dalle; Reid, C.; Zhu, William; Lance, Samuel; Meltzer, Hal S.; Gosman, Amanda

doi:10.1097/prs.0000000000005053

Cited by 16 publications

(44 citation statements)

References 20 publications

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“…13 Distraction osteogenesis for unicoronal craniosynostosis can achieve a significant increase in intracranial volume, with a distraction efficiency of 0.99 to 1.3 percent increase in intracranial volume per millimeter of distraction. 16,17 Compared to conventional fronto-orbital advancement, distraction osteogenesis for unicoronal craniosynostosis can be performed at an earlier age (4.8 months versus 9.3 months) and has decreased duration of surgery (127 minutes versus 169 minutes), decreased intensive care unit length of stay (1.4 days versus 2.8 days), decreased hospital length of stay (2.4 days versus 4.2 days), less overall blood loss (169 ml versus 400 ml), less blood loss as percentage of total blood volume (32 percent versus 58 percent), and decreased transfusion requirements (255 ml versus 538 ml). 13 Endoscope-assisted osteotomies and placement of distractors combines these concepts as we continue to evolve our treatment of unicoronal craniosynostosis.…”

Section: Discussionmentioning

confidence: 99%

Endoscope-Assisted Fronto-Orbital Distraction Osteogenesis

Kalmar

Carlson

Kosyk

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Summary: Anterior cranial vault fronto-orbital distraction osteogenesis is a promising treatment modality for children with unicoronal craniosynostosis. A minimally invasive, endoscope-assisted approach offers the additional potential benefits of less scalp scarring, decreased blood loss, and decreased scalp dissection. In this article, the authors present a novel technique for minimally invasive, endoscope-assisted fronto-orbital distraction osteogenesis.

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Section: Discussionmentioning

confidence: 99%

Endoscope-Assisted Fronto-Orbital Distraction Osteogenesis

Kalmar

Carlson

Kosyk

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Another observation was narrowing of bifrontal and lateral orbital width, which is a well-documented observation following trigonocephaly correction (Wes et al, 2014; Patel et al, 2016). While the cause(s) of such are unclear, it has been hypothesized that it is a combination of soft tissue recoil (ie, scalp and muscle) and devascularized bone (Bennett et al, 2018; Brandel et al, 2018). For this reason and to limit the potential for contour irregularities along the forehead, others have proposed “abandoning the bandeau” for other means of frontal advancement (Fearon et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

A Three-Dimensional-Based Morphometric Analysis of a Standardized Overcorrection Technique for Fronto-Orbital Advancement in Metopic Craniosynostosis

Pfaff

Bruce

Erpenbeck

et al. 2021

The Cleft Palate Craniofacial Journal

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Introduction The concept of “overcorrection” for trigonocephaly has been reported to achieve both anterior cranial fossa expansion and normalization of craniofacial form. The purpose of this study is to describe in detail a standardized technique to fronto-orbital advancement utilizing the concept of “overcorrection” and objectively evaluate intermediate results. Methods This retrospective study included patients with isolated metopic synostosis who underwent surgery via the proposed surgical technique and age and sex-matched unaffected controls. Craniofacial morphometric analysis was performed on pre-, immediate post-, and intermediate postoperative (>2 years) three-dimensional (3D)-rendered computed tomographic (CT) scans and photographs. Key CT-based measurements included interzygomaticofrontal suture distance (IZFS), endocranial bifrontal angle (ECA), and temporal expansion. 3D photogrammetry was performed using established measurements and associated Z-scores converted. A Paired t-test and analysis of variance were performed when appropriate. Results Forty-one patients were included. A comparison of pre- and immediate postoperative CT scans demonstrated statistically significant increases in all measurements. Subset analysis of 12 patients with intermediate follow-up (age: 39.6 ± 3.6 months) demonstrated significant differences from preoperative values except for IZFS, which decreased from immediate postoperative values and was smaller than age- and sex-matched controls. 3D photogrammetry demonstrated a mean Z-score above the norm for frontal breath. 3D photogrammetry is also positively correlated with CT-based measurements. Conclusions This standardized “overcorrection” approach for trigonocephaly can provide the appropriate changes to maintain a normal ECA despite a reduction in bifrontal width over time. 3D photogrammetry positively correlated with CT-based measurements and may provide useful information when following patients clinically. Long-term follow-up assessment to determine the necessary degree of overcorrection at skeletal mature is needed.

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“…Distraction osteogenesis for craniosynostosis may afford a greater degree of osseous movement than could be achieved with conventional cranial vault remodeling intraoperatively due to gradual stretching of soft tissues. Specifically for unicoronal craniosynostosis, distraction osteogenesis has been shown to have a distraction efficiency of 0.99% to 1.3% increase in intracranial volume per millimeter of distraction 22,23 . Gradual expansion minimizes the dead space formed with large immediate movements, which has been shown to decrease the risk of infection in combined cranial-midfacial surgery (ie monobloc advancement) and may decrease risk for transcranial infection in cranial surgery (Fig.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic-Assisted Fronto-Orbital Distraction Osteogenesis: Initial Patient Report

Kalmar

Carlson

Kosyk

et al. 2021

Journal of Craniofacial Surgery

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Background: The purpose of this manuscript is to introduce a novel endoscopic-assisted approach for creation of osteotomies and distractor hardware placement for unicoronal craniosynostosis. Methods: Only three small incisions are performed, one at the anterior fontanelle, pterional region, and upper lateral blepharoplasty location. Unicoronal strip craniectomy and osteotomies in temporal bone, nasofrontal junction, lateral orbital rim, sphenoid wing, orbital roof, and contralateral frontal bone are performed through these incisions with the assistance of a 308 5-mm endoscope. One linear cranial distractor is inserted through the pterional incision and fixated across the unicoronal suturectomy. Results:Endoscopic-assisted fronto-orbital distraction osteogenesis has been performed on 3 patients with unicoronal craniosynostosis. Median age at surgery was 5.4 months (95%CI 5.0-6.1). Median operative duration was 98 minutes (95%CI 91-112), and estimated blood loss was 25 mL (95%CI 15-150). Median length of distraction achieved was 25.7 mm (95%CI 21.9-28.0), based on lateral skull x-rays obtained on the last day of activation. Distractors were removed 2.3 months postoperatively (95%CI 2.1-3.1), and operative duration of distractor removal was 20 minutes (95%CI 19-29). There was 1 complication, a transient cerebrospinal fluid leak thought to have been caused by a pinpoint injury to the dura at the nasofrontal junction, which was managed expectantly and resolved spontaneously by the fourth postoperative day. Conclusions: Endoscopic-assisted fronto-orbital distraction osteogenesis is a promising treatment modality for children with unicoronal craniosynostosis combining the benefits of distraction osteogenesis with a minimally invasive approach. Additional experience and follow-up are needed to determine its utility, safety, and longevity.

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Distraction Osteogenesis for Unicoronal Craniosynostosis: Rotational Flap Technique and Case Series

Abstract: Therapeutic, IV.

Cited by 16 publications

References 20 publications

Endoscope-Assisted Fronto-Orbital Distraction Osteogenesis

Endoscope-Assisted Fronto-Orbital Distraction Osteogenesis

A Three-Dimensional-Based Morphometric Analysis of a Standardized Overcorrection Technique for Fronto-Orbital Advancement in Metopic Craniosynostosis

Endoscopic-Assisted Fronto-Orbital Distraction Osteogenesis: Initial Patient Report

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