title: One-piece bone flap osteotomy using thread wire saw for fronto-orbital advancement with distraction osteogenesis in craniosynostosis.
abstract: OBJECTIVE
  The objectives of this study are to describe our new technique of one-piece bone flap osteotomy for fronto-orbital advancement with distraction osteogenesis in craniosynostosis using a thin, flexible, and safe thread wire saw (the T-saw) and to compare the results with those of classic osteotomy using an osteotome.
  
  
  METHODS
  Initial osteotomy is performed between two pterion burr holes using a craniotome with a guarded footplate. The outer sphenoid wing and lateral orbital rim are separated using a reciprocating saw. Limited dura dissection from inner cortex between burr holes in the pterion and nasion is performed. The T-saw is inserted through the epidural space behind the superior orbital wall between the lateral orbital rim and nasion burr hole; the osteotomy is performed with gentle reciprocating strokes. Dura protection with a malleable retractor is not absolutely necessary.
  
  
  RESULTS
  Five patients underwent one-piece fronto-orbital bone flap osteotomies using a T-saw in 2009-2014. The median age was 26 months (7-132 months), median operation time was 275 min (183-303 min), and median estimated blood loss was 65 mL (20-250 mL). These values did not differ from those of control cases. No complications, including incomplete osteotomy, occurred.
  
  
  CONCLUSIONS
  The T-saw creates an osteotomy as a "one-stroke sketch," so incomplete osteotomy never occurs. The osteotomy can be performed safely without protecting the dura. Osteotomy with T-saw does not negate the advantages of fronto-orbital advancement with distraction osteogenesis, including shorter operative time, less intraoperative bleeding, and fewer complications.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan, m-y@kanazawa-med.ac.jp.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yamashita
authors.forename: Takuya
authors.initials: T
authors.lastname: Akai
authors.forename: Miyuki
authors.initials: M
authors.lastname: Kishibe
authors.forename: Kenichi
authors.initials: K
authors.lastname: Shimada
mesh_terms: D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D061646:Operative Time; D019857:Osteogenesis, Distraction / Q000295:instrumentation* / Q000379:methods*; D010027:Osteotomy / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps