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Correction of Sagittal Craniosynostosis Using Distraction Osteogenesis Based on Strategic Categorization

 Myung Chul Lee  ;  Kyu Won Shim  ;  In Sik Yun  ;  Eun Kyung Park  ;  Yong Oock Kim 
 Plastic and Reconstructive Surgery, Vol.139(1) : 157-169, 2017 
Journal Title
 Plastic and Reconstructive Surgery 
Issue Date
Cephalometry/methods ; Child ; Child, Preschool ; Craniosynostoses/diagnosis ; Craniosynostoses/surgery* ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Neuropsychological Tests ; Osteogenesis, Distraction/methods* ; Osteotomy ; Tomography, X-Ray Computed ; Treatment Outcome
BACKGROUND: Distraction osteogenesis has been used to correct sagittal craniosynostosis in various ways. The purpose of this study was to introduce three distraction osteogenesis procedures by describing four objective measurements. METHODS: Fifty-four patients with sagittal synostosis were recruited and assigned to one of three therapeutic groups: group 1, anteroposterior compression with bitemporal expansion (n = 35); group 2, bitemporal expansion (n = 9); and group 3, anteroposterior expansion with bitemporal expansion (n = 10). Distraction procedures were performed while maintaining dural attachment. Four indices-namely cranial index, head circumference, intracranial volume, and neurodevelopmental index (using the Bayley Scales of Infant Development II), were analyzed. RESULTS: The preoperative cranial index of group 1 (68.51 ± 4.73) differed significantly from those of groups 2 (76.75 ± 2.4; p < 0.05) and 3 (86.8 ± 3.99; p < 0.05). Postoperative cranial index in all groups converged to the mesocephalic cranial index. Preoperative intracranial volume determinations were within the normal range for the majority of participants in groups 1 and 2; however, most fell below -1 SD in group 3 [n = 8 (80 percent)]. Postoperatively, 90 percent of group 3 participants had intracranial volume values within the normal range. The preoperative mental and psychomotor developmental indices of group 3 were significantly lower than those in the other two groups. The postoperative analysis showed significant improvement in these indices in groups 1 and 3 or when all patients were analyzed. CONCLUSION: Symmetric sagittal synostosis can be effectively treated with distraction osteogenesis reformation guided by strategic categorization. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
김용욱(Kim, Yong Oock) ORCID logo https://orcid.org/0000-0002-3756-4809
박은경(Park, Eun Kyung)
심규원(Shim, Kyu Won) ORCID logo https://orcid.org/0000-0002-9441-7354
윤인식(Yun, In Sik) ORCID logo https://orcid.org/0000-0003-1103-7047
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