Journal
JOURNAL OF CRANIOFACIAL SURGERY
Volume 26, Issue 6, Pages 1904-1908Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/SCS.0000000000002020
Keywords
Distraction osteogenesis; unicoronal craniosynostosis; cranial vault remodeling
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Funding
- Department of Surgery of The Children's Hospital of Philadelphia
- Perelman School of Medicine at the University of Pennsylvania
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Fronto-orbital advancement and remodeling (FOAR) remains the most widely practiced treatment of unicoronal craniosynostosis (UCS) despite recent studies of ocular dysfunction and aesthetic shortcomings in the long-term. The aim of the study was to compare perioperative morbidity and short-term outcomes of a recently developed, nondevascularizing, distraction-based treatment of UCS with conventional FOAR. To do so, the authors compared the first 6 patients who were treated with a new osteotomy/distraction approach to the last 6 patients who underwent traditional FOAR for the treatment of UCS with regards to demographics, operative details, perioperative morbidity, and short-term outcomes.Between July 2012 and June 2014, 6 patients underwent each procedure. Duration of surgery and length of hospital stay in the distraction group were on average 2hours 7 minutes and 3.4 days, respectively, significantly less than in the traditional FOAR group (P=0.039, P=0.032, respectively). Perioperative blood loss averaged 169mL, which trended toward less than in the traditional group (mean of 400mL, P=0.065). Patients undergoing conventional compared with distraction osteogenesis-mediated FOAR were significantly more likely to develop new-onset strabismus postoperatively (odds ratio 15.4; P=0.0384). All 12 patients completed therapy without complications and with Whitaker grade I results at latest follow-up.In the perioperative period, distraction-mediated cranial vault remodeling provides similar correction of the aesthetic deformity associated with UCS and an improved morbidity profile. Longer follow-up is needed to determine how distraction compares with FOAR with respect to neuropsychologic and long-term aesthetic outcomes.
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