title: Cranial remodeling to treat craniosynostosis by gradual distraction using a new device.
abstract: OBJECTIVE
  The authors describe their experience in remodeling the shape of the cranium in children with craniosynostosis by using gradual distraction. In half of the cases, a new distraction device developed by the authors was used.
  
  
  METHODS
  Twenty children with craniosynostosis underwent frontoorbital advancement and cranial remodeling assisted by gradual distraction. There were five children with brachycephaly, two with oxycephaly, five with scaphocephaly, two with plagiocephaly, one with combined scaphocephaly and plagiocephaly, and five with trigonocephaly. Four cases were syndromic and 16 were nonsyndromic. The patients ranged in age from 3 to 50 months (mean 14.5 months) at the first surgery. Simulated surgery was first performed on a three-dimensional solid model made of polyurethane, which accurately represented cranial flexibility, to determine the most favorable osteotomy line. Distraction was initiated 1 week postoperatively. The speed and extent of advancement (maximum extension 45 mm) were predetermined on the basis of previously reported criteria and the results of simulated surgery. Postoperatively, the cranial configuration was favorable in all cases. Spontaneous remodeling of irregularities and/or gaps apparent after distraction was found to occur 2 to 5 months after removal of the distraction devices, especially in patients with trigonocephaly or scaphocephaly. No major perioperative complication was observed in any patient. There were minor complications in six of the first 10 cases, including exposure of the device, shaft slippage, and fluid discharge. A new device was developed and used on the last 10 patients treated; it successfully eliminated device exposure and shaft slippage. A 3-year follow-up review confirmed that there was no relapse of advanced bones.
  
  
  CONCLUSIONS
  Highly satisfactory results were achieved in cases of both syndromic and nonsyndromic craniosynostosis when gradual distraction was performed.
authors: Department of Plastic and Reconstructive Surgery, Osaka City General Hospital, Japan. imai-k@sc.vpclub.net
authors: Keisuke
authors: K
authors: Imai
authors: Hiroyuki
authors: H
authors: Komune
authors: Chiaya
authors: C
authors: Toda
authors: Takeru
authors: T
authors: Nomachi
authors: Eiji
authors: E
authors: Enoki
authors: Hiroaki
authors: H
authors: Sakamoto
authors: Shohei
authors: S
authors: Kitano
authors: Mitsuo
authors: M
authors: Hatoko
authors: Takuya
authors: T
authors: Fujimoto
mesh_terms: D016723:Bone Remodeling / Q000502:physiology*; D002675:Child, Preschool; D003398:Craniosynostoses / Q000503:physiopathology* / Q000601:surgery*; D004867:Equipment Design; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D019857:Osteogenesis, Distraction / Q000295:instrumentation* / Q000379:methods*; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods; D012886:Skull / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome