Ocular advancement in monobloc distraction.
BACKGROUND
Monobloc distraction has been demonstrated to be an efficacious, safe, and stable method of providing functional and aesthetic improvement in children with syndromic craniosynostosis. Although the movement of bony structures following monobloc distraction has been quantitatively assessed before, objective analysis of the movement of soft tissues, such as the globe, has not been published previously. The authors present a method that assesses globe movement following monobloc distraction, using computed tomographic scan data.


METHODS
The preoperative and postoperative computed tomographic scans of 10 patients with Pfeiffer's and Crouzon's syndromes, undergoing monobloc distraction, were assessed. Scan data were loaded into voxel image-rendering software that produced a three-dimensional reconstruction. Direct measurements between preoperative and postoperative images were taken.


RESULTS
An average upper face osseous distraction distance of 12.94 mm, with an average lower face distraction of 14.19 mm, was achieved in all 10 children. The authors measured average globe movements on three planes and calculated an average left eye forward movement of 5.28 mm and average right eye forward movement of 6.33 mm. In all, globe advancement was approximately two fifths of the distance advanced by the surrounding bone.


CONCLUSIONS
Forward movement of the globe following monobloc distraction has not previously been described. Although there is no current evidence for optic nerve stretch and compromise in monobloc surgery, the functional implications of these findings should be formally assessed.
O'Connor
Edmund J Fitzgerald
EJF
London, United Kingdom From The Craniofacial Unit, Great Ormond Street Hospital for Children.
Marucci
Damian D
DD
Jeelani
Nu Owase
NO
Witherow
Helen
H
Richards
Robin
R
Dunaway
David J
DJ
Hayward
Richard D
RD
D000168:Acrocephalosyndactylia / Q000601:surgery*; D002508:Cephalometry; D002648:Child; D003394:Craniofacial Dysostosis / Q000601:surgery*; D005123:Eye; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D009915:Orbit / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed