Use of distraction osteogenesis for unicoronal craniosynostosis
Gregory G. Heuer, Ian Hoppe, Lawrence Lin, Rosaline Zhang, Scott Bartlett, Jesse Taylor
Children's Hospital of Philadelphia, Philadelphia PA, USA
Patients with unicoronalcraniosynostosis (UCS) are traditionally treated with frontoorbital advancement (FOA). While effective, FOA can associated with significant blood loss and a tendency for postoperative ocular dismotility. Distraction osteogenesis (DO) has been successfully applied to other craniofacial abnormalties.We describe the use of DO in the treatment of UCS, comparing the outcomes to FOA.
Patients undergoing DO for UCS at our institution (13 patients) were compared to the most recent 13 patients undergoing FOA. Patient age, operative time, blood loss, blood replacement, length of stay (LOS), complications and the development of new onset strabismus following surgery were documented.
Figure 1-Representative example-3 month old female w/ Right unicoronal synostosis, A,B) Pre-op appearance, C,D) Pre-op 3-D HCT, E) intraoperative view, F) Immediate Post-op radiograph, G) 3 month post-distration radiograph, H) Pre-op appearance, I) 3 month appearance, J) 1 year appearance.
Table 1 –Clinical Characteristics of patients with distraction osteogenesis (DO) and traditional fronto-orbital advancement (FOA). 13 DO patients, 13 FOA patients.
Table 2 –Ophthalmologic variables in pateints with distraction osteogenesis (DO) and traditional fronto-orbital advancement (FOA).
A chi-square analysis and student’s t test were utilized for analysis. Mean follow-up time was 1.9 years in the DO group and 2.4 years in the FOA group. Patients undergoing DO compared to FOA were significantly younger (6.4 and 9.6 months, p 0.02), experienced significantly less operative time (114.6 and 196.5 minutes, p < 0.01), significantly less blood loss and less blood replacement. The mean distance distracted was 36mm in the DO group. One patient in the DO group experienced a new-onset strabismus postoperatively compared with 5 in the FOA group.
DO for the treatment of UCS provides a favorable risk profile compared with traditional FOA. The trend towards a decreased incidence of postoperative strabismus suggests that gradual movement of the orbit is favorable with regards to the accommodation of ocular muscles to the new orbital position