Distraction of Fronto-Orbital Segment as a Nonvascularized Bone Graft in Craniosynostotic Patients.

Fronto-orbital advancement using distraction techniques involves the dura left attached to the osteotomized bone segment to avoid dead space formation and dural injury, whereas it is impossible to reshape the supraorbital bar and the frontal bone complex, when necessary. Our approach combines advantageous parts of conventional and distraction osteogenesis techniques as remodel and distract the supraorbital bar and frontal bone complex as a free bone graft. Twenty-seven patients either being syndromic and nonsyndromic craniosynostosis, with at least 3 years of follow-up were reviewed in this study. Mean age of the patients at the time of the operation was 23.44 +/- 18.42 months and mean operative time was 4.96 +/- 0.97 hours. Blood transfusion was required in all patients, with an average of 112.04 +/- 44.60 mL. Amount of the distraction ranged 10 to 30 mm, a mean of 17.26 +/- 4.71 mm for the right side and 18.15 +/- 4.69 mm for the left side. Mean duration of consolidation was 98.26 +/- 12.98 days and mean follow-up was 41.33 +/- 22.92 months. In this study, result of internal distraction of fronto-orbital segment as a nonvascularized bone graft in craniosynostotic patients is reviewed to emphasize the efficacy of the nonvascularized bone graft distraction in management of craniosynostosis. Graft distraction after fronto-orbital and cranial vault remodeling appears to be safe and effective approach in correcting severe craniosynostosis deformities especially necessitating asymmetrical advancement. (C) 2017 by Mutaz B. Habal, MD.

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