Distraction osteogenesis in craniosynostosis

Abstract

Purpose of review Craniosynostosis, a condition of premature cranial suture fusion, can have significantly detrimental effects on development and growth due to sequelae of increased intracranial hypertension (ICP), exophthalmos, and upper airway obstruction. Evolving surgical treatments now include distraction osteogenesis (DO) due to its many benefits relative to standard cranial vault remodeling procedures. This article provides an overview and update of different surgical applications of DO for patients with craniosynostosis. Recent findings DO has been utilized successfully for single and multisuture craniosynostosis with or without midface hypoplasia to increase intracranial volume, decrease ICP and improve aesthetics. It has been applied in single suture synostosis, posterior vault DO, fronto-orbital advancement, monobloc DO and Le Fort III DO. DO has been applied through modification of traditional surgical procedures with success in maintaining goals of surgery while reducing risk. Summary DO is still a relatively new and evolving surgical technique for patients with syndromic and nonsyndromic craniosynostosis. With promising benefits, consideration for each procedure should be weighed until longer-term data is available.

Craniofacial Distraction Osteogenesis

“…This can have deleterious effects on the developing child, as it affects neurocognitive function, vision, and, if left untreated, even death. [14][15][16] Additionally, many of these patients develop cerebellar tonsillar herniation or Chiari malformation. 17 While elevated ICP can be seen with nonsyndromic craniosynostosis, it is more often encountered with syndromic craniosynostosis such as Apert's, Crouzon's, Muenke's, Saethre-Chotzen, and Pfeiffer's syndromes.…”

“…17 While elevated ICP can be seen with nonsyndromic craniosynostosis, it is more often encountered with syndromic craniosynostosis such as Apert's, Crouzon's, Muenke's, Saethre-Chotzen, and Pfeiffer's syndromes. 5,15 In the setting of multisuture craniosynostosis, the goal of cranial vault distraction is to increase cranial vault volume, relieve intracranial hypertension, and allow for unrestricted brain growth and development. 2 Prior to DO, anterior cranial vault expansion was performed using either fronto-orbital advancement (FOA) or monobloc advancement, both of which have been associated with relapse and morbid complications.…”

“…FOA is primarily used in craniosynostosis involving the coronal and metopic sutures, as premature suture fusion results in facial deformity such as exorbitism and frontotemporal narrowing. 15,45 FOA addresses these issues by correcting forehead contour and advancing the fronto-orbital complex around the age of 10 to 15 months. 25 The traditional procedure involves a frontal craniotomy consisting of a lower forehead and supraorbital bar that are osteotomized from the craniofacial skeleton and remodeled intraoperatively.…”

“…Internal distractors are placed in the parietal region and attached to the frontal bone flap for anterior advancement. 15 The latency period depends on the age of the patient, with 0 to 1 day for children under the age of 1 year, and 3 to 5 days for children older than 1 year. 50 Distraction occurs at a rate of 1 mm/d until correction of exorbitism is achieved, with a consolidation period of 12 weeks.…”

Global trends and current status of distraction osteogenesis: Bibliometric analysis of publications from 1980 to 2021

“…From 1980 to 2021, more and more publications have reported the clinical application of DO in orthopaedics, oral and maxillofacial surgery and neurosurgery around the world ( Sandhaus and Johnson, 2021 ; Shevtsov and Leonchuk, 2021 ; Kosyk et al, 2022 ). However, the bibliometric analysis on the global trend and status of DO is relatively rare.…”