Department of Pediatric Plastic Surgery, Jichi Children's Medical Center Tochigi, 3311-1, Yakushiji, Shimotsuke, 329-0498 Tochigi, Japan; Department of Plastic Surgery, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, 329-0498, Tochigi, Japan.
Lilla Craniofacial Clinic Tokyo, 1-7-17, Ginza, Chuo-ku, 104-0061, Tokyo, Japan.
J Craniomaxillofac Surg. 2019 Sep;47(9):1436-1440. doi: 10.1016/j.jcms.2019.06.014. Epub 2019 Jun 25.
Fronto-orbital advancement by distraction osteogenesis is a useful means of surgically correcting bicoronal synostosis. However, the scope for morphological revision is limited. To address this issue, we developed a multidirectional cranial distraction osteogenesis (MCDO) technique that we quantitatively assessed in patients with bicoronal synostosis. In this case series, five patients with bicoronal synostosis were treated with MCDO at a mean age of 13.4 months (range 9-22 months). Distraction started 5 days after surgery and the activation period was 11.2 days (range 10-14 days). The distraction devices were removed 47.2 days (range 33-67 days) after completing distraction. Improved cranial shape was confirmed by CT data. Mean preoperative CI, APL, and ICV readings of 102.1%, 13.5 cm, and 1179.4 ml, respectively, had reached 94.0%, 14.9 cm, and 1323.9 ml, respectively, upon device removal. These values were well preserved at 1 year (90.4%, 15.8 cm, and 1461.3 ml, respectively). In conclusion, MCDO successfully enables both cranial expansion and correction of a flat forehead, constituting a valid treatment alternative for patients with bicoronal synostosis.
经牵引性骨生成行额眶前移术是一种矫正矢状缝早闭的有效方法。然而，这种方法在形态学修正方面的应用范围有限。为了解决这个问题，我们开发了一种多方向颅骨牵引性骨生成（MCDO）技术，并在矢状缝早闭患者中对其进行了定量评估。在本病例系列研究中，5 例矢状缝早闭患者在平均 13.4 月龄（9-22 月龄）时接受 MCDO 治疗。术后 5 天开始牵引，激活期为 11.2 天（10-14 天）。完成牵引后 47.2 天（33-67 天）取出牵引器。通过 CT 数据证实了颅骨形状的改善。平均术前 CI、APL 和 ICV 读数分别为 102.1%、13.5cm 和 1179.4ml，在拆除设备时分别达到 94.0%、14.9cm 和 1323.9ml，在 1 年时保持良好，分别为 90.4%、15.8cm 和 1461.3ml。总之，MCDO 成功地实现了颅骨扩张和平坦额部的矫正，为矢状缝早闭患者提供了一种有效的治疗选择。
