Treating unilateral coronal synostosis in infant: internal forehead distraction and induced osteogenesis of supraorbital margin of frontal bone
10.3760/cma.j.issn.1009-4598.2018.01.006
- VernacularTitle: 患侧眶缘斜行截骨联合额骨瓣牵张成骨术治疗婴儿单侧冠状缝早闭
- Author:
Weimin SHEN
1
;
Jie CUI
;
Jianbing CHEN
;
Yi JI
;
Jijun ZOU
Author Information
1. Department of Plastic Surgery, Children′s Hospital of Nanjing Medical University, Nanjing 210008, China
- Publication Type:Clinical Trail
- Keywords:
Osteogenesis, Distraction;
Craniosynostosis;
Coronal suture;
Orbital margin;
Osteotomy
- From:
Chinese Journal of Plastic Surgery
2018;34(1):23-27
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate a new method to treat unilateral coronal synostosis.
Methods:2 cm-wide osteotomy was performed over the fused unilateral coronal suture.Oblique osteotomy was performed along the supraorbital rim to do a frontal suture of the glabella (patients less than one year old) or on the opposite side of the supraorbital rim (patients over one year old) after performing a suturectomy of the effected coronal suture. Two internal distraction devices were subsequently placed across the osteotomized, fused coronal suture. At the top of the unfused metopic suture, bring two holes and fixing with 4-0 absorbable suture.Finally, the cranium pieces were divided into 2 pieces and placed in the middle of the frontal bone using biological glue or titanium screws. Five days after the operation, a 0.6 mm distraction was performed twice per day. The distraction was removed 6 months after distraction reaching 30—60 mm.
Results:Internal distraction osteogenesis with supraorbital oblique osteotomy was performed in eleven patients suffering from unilateral coronal synostosis from 2014.1 to 2017.1. All the patients had no abnormalities in nerve system, such as cephalomeningitis/ fistaul of cerebrospinal fluid/ epidural hematoma and so on.The distractor was not exposed. The width of extension ranged from 25—39 mm. One patient had infection in the rods around the distraction during the period of fixed, but was cured with antibiotic treatment and got an ideal extension eventually. The rest of 10 patients obtained the expected result . During a mean follow-up period of 12 months (5 to 26 months), all patients were presented with satisfactory cosmetic and functional result . CVAI were close to normal.
Conclusions:Treating unilateral coronal synostosis by internal distraction osteogenesis with supraorbital oblique osteotomy reduces the necessity offrontal and supraorbital osteotomy, and the exposure of the base of anterior cranial fossa, renders a safe and effective approach.
