Use of distraction osteogenesis to change endocranial morphology in unilateral coronal craniosynostosis patients.
BACKGROUND
The endocranial morphology of the skull base is an important factor in determining craniofacial asymmetry. Moreover, although the patency of cranial suture would be the first determining factor, unicoronal, unilambdoid synostosis and deformational plagiocephaly can also be differentiated by means of axis angulation of anterior and posterior cranial fossa. These findings indicate the importance of endocranial morphology in craniofacial asymmetry. The authors hypothesized that distraction of the skull base might cause stress on the skull base that could modify skull base angulation deformities.


METHODS
This study compared the distraction technique with traditional bone repositioning techniques for remodeling skull base axis deformities in synostotic plagiocephaly patients. The study recruited 19 unicoronal craniosynostotic patients, of whom seven underwent distraction treatment and 12 underwent traditional bone graft treatment.


RESULTS
The authors found that both approaches resulted in successful outcomes in terms of exocranial morphology correction, but that the distraction technique may offer advantages over traditional methods. Moreover, the authors found that distraction did modify the skull base angulation. Distraction created more changes in the endocranial morphology. The average correction of skull base angulation with distraction was from 164.6 to 174.3 degrees, whereas the correction for the traditional technique was from 165.2 to 166.2 degrees. The amount of change in skull base axis was statistically significant according to the Mann-Whitney test (p < 0.001), but the change in cranial index of asymmetry was not (p = 0.363).


CONCLUSIONS
The skull base axis in synostotic plagiocephaly, which is composed of the anterior and posterior cranial fossa, underwent greater correction using the distraction method.
Choi
Jong Woo
JW
Seoul, Korea From the Departments of Plastic and Reconstructive Surgery and Neurosurgery, Ulsan University, College of Medicine, and Young Nam University, College of Medicine, Seoul Asan Medical Center.
Ra
Young Shin
YS
Hong
Seok Ho
SH
Kim
Hoon
H
Shin
Hyun Woo
HW
Chung
In Wook
IW
Kim
Tae Gon
TG
Park
Sang Hoon
SH
Koh
Kyung S
KS
D002675:Child, Preschool; D003398:Craniosynostoses / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019857:Osteogenesis, Distraction
Hansen M, Mulliken JB. Frontal plagiocephaly: Diagnosis and treatment. Clin Plast Surg. 1994;21:543–553.
Virchow R. Über den Cretinismus, namentlich in Franken, und über pathologische Schädelformen. Verh Phys Med Ges Wurzburg 1851;2:230–271.
Cunningham ML, Heike CL. Evaluation of the infant with an abnormal skull shape. Curr Opin Pediatr. 2007;19:645–651.
Jackson IT, Costanzo C, Marsh WR, Adham M. Orbital expansion in plagiocephaly. Br J Plast Surg. 1988;41:16–19.
Loomis MG, Radkowski MA, Pensler JM. Maxillary deformation in unilateral coronal synostosis. J Craniofac Surg. 1990;1:73–76.
Moss ML. Functional anatomy of cranial synostosis. Childs Brain 1975;1:22–33.
Genitori L, Zanon N, Denis D, et al. The skull base in plagiocephaly. Childs Nerv Syst. 1994;10:217–223.
Lo LJ, Marsh JL, Pilgram TK, Vannier MW. Plagiocephaly: Differential diagnosis based on endocranial morphology. Plast Reconstr Surg. 1996;97:282–291.
Francel PC, Park TS, Marsh JL, Kaufman BA. Frontal plagiocephaly secondary to synostosis of the frontosphenoidal suture: Case report. J Neurosurg. 1995;83:733–736.
Perks J. Plagiocephaly: What is the cause? Aust Fam Physician 1998;27:461.
Bartlett SP, Whitaker LA, Marchac D. The operative treatment of isolated craniofacial dysostosis (plagiocephaly): A comparison of the unilateral and bilateral techniques. Plast Reconstr Surg. 1990;85:677–683.
Marsh JL, Gado MH, Vannier MW, Stevens WG. Osseous anatomy of unilateral coronal synostosis Cleft Palate J. 1986;23:87–100.
Choi JW, Koh KS, Hong JP, Hong SH, Ra Y. One-piece frontoorbital advancement with distraction but without a supraorbital bar for coronal craniosynostosis. J Plast Reconstr Aesthet Surg. 2009;62:1166–1173.
Zonenshayn M, Kronberg E, Souweidane MM. Cranial index of symmetry: An objective semiautomated measure of plagiocephaly. Technical note. J Neurosurg. 2004;100:537–540.
Bruner TW, David LR, Gage HD, Argenta LC. Objective outcome analysis of soft shell helmet therapy in the treatment of deformational plagiocephaly. J Craniofac Surg. 2004;15:643–650.
Shin JH, Persing J. Asymmetric skull shapes: Diagnostic and therapeutic consideration. J Craniofac Surg. 2003;14:696–699.
Dohn DF. Surgical treatment of unilateral coronal craniostenosis (plagiocephaly): Report of three cases. Cleve Clin Q. 1963;30:47–54.
Kreiborg S, Bjork A. Craniofacial asymmetry of a dry skull with plagiocephaly. Eur J Orthod. 1981;3:195–203.
Kane AA, Lo LJ, Vannier MW, Marsh JL. Mandibular dysmorphology in unicoronal synostosis and plagiocephaly without synostosis. Cleft Palate Craniofac J. 1996;33:418–423.
Miller RI, Clarren SK. Long-term developmental outcomes in patients with deformational plagiocephaly. Pediatrics 2000;105:E26.
Sakurai A, Hirabayashi S, Sugawara Y, Harii K. Skeletal analysis of craniofacial deformities in brachycephaly: Comparison with craniofacial deformities in plagiocephaly. Scand J Plast Reconstr Surg Hand Surg. 2001;35:165–175.
Besson A, Pellerin P, Doual A. Study of asymmetries of the cranial vault in plagiocephaly. J Craniofac Surg. 2002;13:664–669.
Peitsch WK, Keefer CH, LaBrie RA, Mulliken JB. Incidence of cranial asymmetry in healthy newborns. Pediatrics 2002;110:e72.
St John D, Mulliken JB, Kaban LB, Padwa BL. Anthropometric analysis of mandibular asymmetry in infants with deformational posterior plagiocephaly. J Oral Maxillofac Surg. 2002;60:873–877.
Meara JG, Burvin R, Bartlett RA, Mulliken JB. Anthropometric study of synostotic frontal plagiocephaly: Before and after fronto-orbital advancement with correction of nasal angulation. Plast Reconstr Surg. 2003;112:731–738.
Baumler C, Leboucq N, Captier G. Mandibular asymmetry in plagiocephaly without synostosis (in French). Rev Stomatol Chir Maxillofac. 2007;108:424–430.
Lee RP, Teichgraeber JF, Baumgartner JE, et al. Long-term treatment effectiveness of molding helmet therapy in the correction of posterior deformational plagiocephaly: A five-year follow-up. Cleft Palate Craniofac J. 2008;45:240–245.
Plooij JM, Verhamme Y, Berge SJ, van Lindert EJ, Borstlap-Engels VM, Borstlap WA. Unilateral craniosynostosis of the frontosphenoidal suture: A case report and a review of literature. J Craniomaxillofac Surg. 2009;37:162–166.
Sgouros S. Skull vault growth in craniosynostosis. Childs Nerv Syst. 2005;21:861–870.
Cho BC, Hwang SK, Uhm KI. Distraction osteogenesis of the cranial vault for the treatment of craniofacial synostosis. J Craniofac Surg. 2004;15:135–144.
Gosain AK. Plastic Surgery Educational Foundation data committee. Distraction osteogenesis of the craniofacial skeleton safety and efficacy report. Plast Reconstr Surg. 2001;107:278–287.