Comparison of Distraction Osteogenesis and Single-Stage Remodeling for Correction of Unilateral Coronal Craniosynostosis

Abstract

Background: Unilateral coronal craniosynostosis is a challenging condition in craniofacial surgery. Frontoorbital advancement by single-stage resorbable remodeling and distraction osteogenesis (DO) techniques have known intraoperative differences, but their comparative outcomes are less well characterized. Methods: A systematic literature search of the MEDLINE, EMBASE, LILACS, and Web of Science databases was conducted. The search was performed using terms related to craniosynostosis and its operative management. The primary outcome of interest was the Whitaker classification. Secondary outcomes included cranial volume or cranial index change, and infection and reoperation rates. Results: A total of 6978 eligible articles were identified of which 26 met inclusion criteria. A total of 292 patients were included in the studies, with 223 undergoing a single-stage remodeling procedure (76.4%) and 69 DO procedures (23.6%). There was a trend toward patients with DO having better Whitaker aesthetic outcomes. Only 2 studies reported volumetric changes. There was a substantial difference in planned and unplanned reoperation rates but not in infection rates. Conclusion: The results of this systematic review suggest that the techniques have similar outcomes and complications, although there was a trend toward better Whitaker outcomes with DO procedures. Inherent to the DO technique is the need for multiple operations to both insert and remove internal hardware which may affect the overall cost effectiveness.

Perioperative Comparison Between Open Cranial Vault Remodeling and Distraction Osteogenesis for Unilateral Lambdoid Craniosynostosis

“…Previous literature comparing these 2 techniques in patients with unicoronal craniosynostosis showed similar results, with a low risk of unplanned reoperation 15 and a higher incidence of dural tear in the OCVR cohort compared with the DO cohort. 13…”

“…4 Many techniques have been described for the treatment of patients with ULS, such as endoscopic suturectomy, distraction osteogenesis (DO), open posterior calvarial reconstruction, and bone-flap remodeling or switching. [1][2][3][4][5][6][7][8][9][10][11][12][13] At the time of this writing, the most common treatment for ULS was open posterior cranial vault remodeling (OCVR), however, reports on the effectiveness of this technique for treating this condition have been mixed. Zoller et al 12 indicated that OCVR resulted in the normalization of intracranial pressure and produced consistently favorable esthetic outcomes in patients with ULS.…”

Comparison of the Relapse Ratio and Osteogenesis Between 1-Piece and 2-Piece Fronto-Orbital Distraction Osteogenesis Among Patients With Bilateral Craniosynostosis in Early Childhood

“…18 However, they noticed that there was no significant difference between the 2 surgical modalities. 17 However, because their analysis included both 1-piece and 2-piece FODO, the difference between FODO and FOAR was reduced. Consequently, further long-term research on 1-piece FODO is needed to clarify the advantages of FODO over FOAR.…”

“…Corkum et al 17 conducted a systematic literature review including 223 FOAR and 69 FODO in patients with unilateral coronal synostosis 18 . However, they noticed that there was no significant difference between the 2 surgical modalities 17 . However, because their analysis included both 1-piece and 2-piece FODO, the difference between FODO and FOAR was reduced.…”

“…8,15 Fearon et al 16 compared the anthropometrics of FOAR to that of FODO after surgery. 17 They concluded that FODO had no substantial benefit in anthropometrics. They did, however, separate the dura-bone connection, as in 2-piece FODO, which might have reduced the effect of FODO, as in 2-piece FODO.…”