Cranial growth after distraction osteogenesis of the craniosynostosis

Abstract

The authors describe the continuance of the growth of the distracted cranium after the reshaping of the cranium by distraction osteogenesis (DO) in children with simple symmetric and asymmetric craniosynostosis. From 2000 until 2002, 9 children with simple craniosynostosis underwent cranial reshaping by gradual distraction using an external distraction device. Four patients have symmetric deformities caused by bicoronal and sagittal craniosynostosis, and 5 patients have asymmetric deformities caused by unicoronal and unilambdoidal craniosynostosis. The distraction device was developed and applied by the author. Preoperative simulation surgery was done on the three-dimensional rapid prototyped model and on the three-dimensional computerized tomography scan to determine the favorable osteotomy line. The distraction rate was from 1 to 1.5 mm/d, and the latency period was from 1 to 5 days. The extent of distraction was determined on the basis of the results of simulation surgery and the change of external appearance. Evaluation of the growth of reshaped cranium was processed from the data of the reconstructed three-dimensional computerized tomography scans before operation, immediate end of distraction, and the last follow-up time. The anteroposterior length and bitemporal width were measured in symmetric synostosis cases, and the distance from supratrochlear notch to occiput was measured in asymmetric synostosis cases. The results showed that the immediate morphologic changes of cranium after DO were maintained in both symmetric and asymmetric synostosis up to the last follow-up without evidence of relapse. Cases of asymmetric deformity also showed that the affected side and the unaffected side had grown with the maintenance of the symmetry that was corrected at the immediate end of the distraction. The cranium modified by the DO was well maintained with the children's growth without any signs of recurrent restricted growth of the original disease. The corrected symmetry of asymmetric deformity was well maintained during a long-term follow-up period as well