title: A novel craniofacial osteogenesis distraction system enabling control of distraction distance and vector for the treatment of syndromic craniosynostosis.
abstract: BACKGROUND
  Distraction osteogenesis is now an important clinical tool in craniofacial surgery. However, controlling the distance and vector of distraction in infants with syndromic craniosynostosis with good repeatability is a task that still proves difficult today. We have developed a new facial osteogenesis distraction system that combines the advantages of external and internal distraction devices to enable control of both the distraction distance and vector. This article describes the method and short-term results of this system.
  
  
  METHODS
  Our distraction system uses both a conventional external distraction device and a newly developed internal distraction device. Postoperative control of the distraction vector is performed using the external device, whereas control of distraction distance is done with the adjustable-angle internal device. This system was used for 2 patients with Crouzon syndrome.
  
  
  RESULTS
  The system enabled control of lengthening distance and vector, and no complications occurred during the procedures.
  
  
  CONCLUSIONS
  We developed a facial distraction system leveraging the advantages of external and internal distraction devices, which we then used to successfully control both lengthening distance and vector. The system would be particularly indicated in patients with severe scarring due to multiple follow-up surgeries and in patients requiring distraction of 20 mm or more. Aligning the periorbital profile at 5 to 6 years old caused the maxilla to rotate counterclockwise, and we consider that a procedure combining Le Fort III osteotomy with Le Fort I and II osteotomies is required to prevent these rotations.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan. skobayashi@kcmc.jp
authors.forename: Shinji
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishiouri
authors.forename: Jiro
authors.initials: J
authors.lastname: Maegawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Hirakawa
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Fukawa
mesh_terms: D002648:Child; D003394:Craniofacial Dysostosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019857:Osteogenesis, Distraction / Q000295:instrumentation*; D019340:Osteotomy, Le Fort; D016896:Treatment Outcome