Monobloc Advancement by Distraction Osteogenesis Decreases Morbidity and Relapse

Bradley, James P.; Gabbay, Joubin S.; Taub, Peter J.; Heller, J; O’Hara, Catherine; Benhaim, Prosper; Kawamoto, Henry K.

doi:10.1097/01.prs.0000233010.15984.4d

Cited by 139 publications

(125 citation statements)

References 30 publications

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“…This is consistent with other published reports. 7,12,51 Our observations are in agreement with those of Bradley et al, 7 who state that there is less morbidity when monobloc advancement is accomplished with distraction osteogenesis than when done in a singlestage surgical procedure; however, Meling et al 38 found no fewer complications. Yonehara et al 60 reported infection around the distracter shaft in 4 of their 19 patients with craniosynostosis treated by distraction osteogenesis.…”

Section: Discussionsupporting

confidence: 82%

“…The disadvantages of distraction osteogenesis are significant but are heavily outweighed by its many advantages. 1,7,10,22,27 Earlier surgery in many of our patients would, in retrospect, have been better, particularly in those with papilledema. In 20 of the patients in this series, there was convincing evidence of intracranial hypertension, but we did not require the presence of papilledema for this determination.…”

Section: Discussionmentioning

confidence: 99%

“…The risks of CSF rhinorrhea, epidural abscess, meningitis, and even frontal bone osteomyelitis and delayed bone resorption are significant. 7 Undercorrection can easily occur and late relapse has been reported following 1-stage corrections. 55 Suboptimal bone positioning and the presence of large or cosmetically objectionable bony defects are not uncommon, and these must either be accepted or corrected via additional surgical procedures with risks that can approach or exceed those of the original surgical undertaking.…”

Section: Discussionmentioning

confidence: 99%

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Cranial vault expansion by distraction osteogenesis

Winston

Ketch

Dowlati³

2011

PED

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Object The object of this report is to present a conceptual and technical approach for expanding the cranial vault, by distraction osteogenesis, in patients with craniocephalic disproportion secondary to pancraniosynostosis and in patients with complex syndromic craniofaciosynostoses undergoing operations for aesthetic improvement. Methods The clinical characteristics, techniques used, outcome and complications for all patients who underwent cranial vault expansions with distraction osteogenesis in Children's Hospital of Denver were reviewed. Results Twenty-six cranial vault expansions were done in 24 patients. Nineteen patients presented with intracranial hypertension. Twelve of these had pancraniosynostosis and 8 had a syndromic diagnosis. Large segments of cranial bone were translated in a controlled manner for distances up to 30 mm. All but one of the patients with intracranial hypertension experienced complete resolution. Conclusions Cranial vault expansion by distraction osteogenesis has the great advantage, as the name implies, of generating new and vascularized autologous bone of the correct shape and in correct locations. The technique, although not simple and not risk free, is much less technically complicated and places patients at lower risk for the most serious complications than does single-stage vault expansion. Less soft tissue dissection and less devascularization of bone are required and there are no postoperative dead spaces. Distraction osteogenesis facilitates far greater vault expansions than do single-stage procedures and can be accomplished in any desired direction.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cranial vault expansion by distraction osteogenesis

Winston

Ketch

Dowlati³

2011

PED

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“…Type XII (fronto-orbital distraction): there has been an important number of publications in the last decade on suture distraction but they usually include few cases 1,18,34,35 . Something similar occurs with combined fronto-orbital and midface advancement 6,7,10,12,28,31,33 although Cruz et al's series on this regard is outstanding 12 . Recently, Pelo et al 35 reviewed exhaustively the current literature that included 130 cases and added 8 personal instances.…”

Section: Complicationsmentioning

confidence: 99%

Surgical treatment of isolated and syndromic craniosynostosis. Results and complications in 283 consecutive cases

et al. 2008

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SummaryObjective. To review the results and complications of the surgical treatment of craniosynostosis in 283 consecutive patients treated between 1999 and 2007.Patients and methods. Our series consisted of 330 procedures performed in 283 patients diagnosed with scaphocephaly (n=155), trigonocephaly (n=50), anterior plagiocephaly (n=28), occipital plagiocephaly (n=1), non-syndromic multi-suture synostosis (n=20), and with diverse craniofacial syndromes (n=32; 11 Crouzon, 11 Apert, 7 Pfeiffer, 2 Saethre-Chotzen, and 2 clover-leaf skull). We used the classification of Whitaker et al. to evaluate the surgical results. Complications of each technique and time of patients' hospitalization were also recorded. The surgeries were classified in 12 different types according to the techniques used. Type I comprised endoscopic assisted osteotomies for sagittal synostosis (42 cases). Type II included sagittal suturectomy and expanding osteotomies (46 cases). Type III encompassed procedures similar to type II but that included frontal dismantling or frontal osteotomies in scaphocephaly (59 cases). Type IV referred to complete cranial vault remodelling (holocranial dismantling) in scaphocephaly (13 cases). Type V belonged to fronto-orbital remodelling without fronto-orbital bandeau in trigonocephaly (50 cases). Type VI included fronto-orbital remodelling without fronto-orbital bandeau in plagiocephaly (14 cases). In Type VII cases of plagiocephaly with frontoorbital remodelling and fronto-orbital bandeau were comprised (14 cases). Type VIII consisted of occipital advancement in posterior plagiocephaly (1 case). Type IX included standard bilateral fronto-orbital advancement with expanding osteotomies (30 cases). Type X was used in multi-suture craniosynostosis (15 cases) and consisted of holocranial dismantling (complete cranial vault remodelling). Type XI included occipital and suboccipital craniectomies in multiple suture craniosynostosis (10 cases) and Type XII instances of fronto-orbital distraction (26 cases).Results. The mortality rate of the series was 2 out of 283 cases (0.7%). These 2 patients died one year after surgery. All complications were resolved without permanent deficit. Mean age at surgery was 6.75 months. According to Whitaker et al's classification, 191 patients were classified into Category I (67.49%), 51 into Category II (18.02%), 30 into Category III (10.6%) and 14 into Category IV (4.90%). Regarding to craniofacial conformation, 85.5 % of patients were considered as a good result and 15.5% of patients as a poor result. Of the patients with poor results, 6.36% were craniofacial syndromes, 2.12% had anterior plagiocephaly and 1.76% belonged to non-syndromic craniosynostosis.The most frequent complication was postoperative hyperthermia of undetermined origin (13.43% of the cases), followed by infection (7.5%), subcutaneous haematoma (5.3%), dural tears (5%), and CSF leakage (2.5%). The number of complications was higher in the group of re-operated patients (12.8% of all). In this subset of reoperations, i...

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“…Other advantages include a reduction in both surgery time and relapse rates. However, patients require further surgery to remove embedded devices following distraction surgery and must wear a halo frame around their head for several months (Bradley et al, 2006).…”

Section: Monobloc Osteotomymentioning

confidence: 99%

Textbook of Plastic and Reconstructive Surgery

Butler¹,

Ghali²,

Kalaskar³

2016

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A CIP catalogue record for this book is available from The British Library.This book is published under a Creative Commons Attribution Non-commercial Non-derivative 4.0 International license (CC BY-NC-ND 4.0). This license allows you to share, copy, distribute and transmit the work for personal and non-commercial use providing author and publisher attribution is clearly stated. Further details about CC BY licenses are available at http://creativecommons.org/ licenses/by/4.0The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. The user is advised to always check the product information and clinical procedures with the most up-to-date published product information and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or misuse or misapplication of material in this work.ISBN: 978-1-910634-37-0 (Hbk.) ISBN: 978-1-910634-38-7 (Pbk.) ISBN: 978-1-910634-39-4 (PDF) ISBN: 978-1-910634-40-0 (epub) ISBN: 978-1-910634-41-7 (mobi)

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Monobloc Advancement by Distraction Osteogenesis Decreases Morbidity and Relapse

Cited by 139 publications

References 30 publications

Cranial vault expansion by distraction osteogenesis

Cranial vault expansion by distraction osteogenesis

Surgical treatment of isolated and syndromic craniosynostosis. Results and complications in 283 consecutive cases

Textbook of Plastic and Reconstructive Surgery

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