Correction of Craniosynostosis Using Distraction Osteogenesis by Gradual Distraction

ABSTRACT

Craniosynostosis is the term that designates premature fusion of one or more sutures in either cranial vault or cranial base. Strip craniectomy had been recorded in the literature before the turn of the century, and remarkable improvements in the correction of the craniosynostosis have taken place. Various surgical methods including frontal bone advancement and cranial vault remodeling have been developed in an effort to correct craniosynostosis. However, the standardized surgical method has not yet been established. Distraction osteogenesis had been developed by Ilizarov to elongate bones without bone graft and the technique was developed so as to lengthen the long bones. Karp and McCarthy reported successful membranous bone lengthening with external devices and noted that cortical bone formed in the expanded area of the mandible. In the field of cranial vault, the technique has been successfully used by Sugawara and many efforts are made to improve cranial vault deformities. There are two possible modes of bone regeneration in case of patients for whom gradual distraction of cranial vault is performed. Bone regeneration of cranial vault may occur from the cut edges of calvaria(distraction osteogenesis) or from islands within the dura mater. We have experienced four patients with craniosynostosis who had undergone surgical correction using distraction device. Because we believed that latent period was not an important factor, we could early initiate distraction schedule. All patients obtained satisfactory results and no relapse was observed during the follow-up period. In conclusion, we believe that latent period would not be an important factor in distraction osteogenesis of cranial vault and the distraction osteogenesis by gradual distraction is useful for the correction of craniosynostosis.