title: A osteogenesis distraction device enabling control of vertical direction for syndromic craniosynostosis.
abstract: BACKGROUND
  We have developed a hybrid facial osteogenesis distraction system that combines the advantages of external and internal distraction devices to enable control of both the distraction distance and vector. However, when the advanced maxilla has excessive clockwise rotation and shifts more downward vertically than planned, it might be impossible to pull it up to correct it. We invented devices attached to external distraction systems that can control the vertical vector of distraction to resolve this problem. The purpose of this article is to describe the result of utilizing the distraction system for syndromic craniosynostosis.
  
  
  METHODS
  In addition to a previously reported hybrid facial distraction system, the devices for controlling the vertical direction of the advanced maxilla were attached to the external distraction device. The vertical direction of the advanced maxilla can be controlled by adjustment of the spindle units. This system was used for 2 patients with Crouzon and Apert syndrome.
  
  
  RESULTS
  The system enabled control of the vertical distance, with no complications during the procedures. As a result, the maxilla could be advanced into the planned position including overcorrection without excessive clockwise rotation of distraction.
  
  
  CONCLUSIONS
  Our system can alter the cases and bring them into the planned position, by controlling the vertical vector of distraction. We believe that this system might be effective in infants with syndromic craniosynostosis as it involves 2 osteotomies and horizontal and vertical direction of elongation can be controlled.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Knagawa Children's Medical Center, Yokohama, Kanagawa, Japan; Fukawa Orthodontic Clinic, Ofuna, Kanagawa, Japan; Hirakawa Orthodontic Clinic, Yokohama, Kanagawa, Japan; and Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Kanagawa, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Knagawa Children's Medical Center, Yokohama, Kanagawa, Japan; Fukawa Orthodontic Clinic, Ofuna, Kanagawa, Japan; Hirakawa Orthodontic Clinic, Yokohama, Kanagawa, Japan; and Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Kanagawa, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Fukawa
authors.affiliation: Department of Plastic and Reconstructive Surgery, Knagawa Children's Medical Center, Yokohama, Kanagawa, Japan; Fukawa Orthodontic Clinic, Ofuna, Kanagawa, Japan; Hirakawa Orthodontic Clinic, Yokohama, Kanagawa, Japan; and Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Kanagawa, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hirakawa
authors.affiliation: Department of Plastic and Reconstructive Surgery, Knagawa Children's Medical Center, Yokohama, Kanagawa, Japan; Fukawa Orthodontic Clinic, Ofuna, Kanagawa, Japan; Hirakawa Orthodontic Clinic, Yokohama, Kanagawa, Japan; and Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Kanagawa, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Maegawa