Fawzy Hossam Hassan, Choi Jong-Woo, Ra Young-Shin
From the Department of Plastic and Reconstructive Surgery, Menoufia University College of Medicine, Shebin Elkom, Egypt.
Departments of Plastic and Reconstructive Surgery.
Ann Plast Surg. 2019 Sep;83(3):285-292. doi: 10.1097/SAP.0000000000001992.
Distraction osteogenesis has gained popularity in the treatment of different types of craniosynostosis. We aimed to present the technique of 1-piece fronto-orbital distraction with midline splitting osteotomy but without bandeau for the treatment of metopic craniosynostosis, and the protocol of outcome evaluation using craniometric, volumetric, and morphologic parameters based on 3-dimensional computer simulation.
This retrospective study included 9 patients with isolated metopic craniosynostosis who underwent surgical correction with distraction osteogenesis between December 2015 and February 2018. The osteotomy was designed in the form of 1-piece fronto-orbital distraction without separation of the orbital bandeau accompanied by midline splitting osteotomy. This was followed by the application of 2 pairs of cranial distractors to produce anterolateral expansion. The 3-dimensional files from preoperative and postdistraction computed tomographic data were used for the measurement of craniometric, volumetric, and morphologic parameters.
The postdistraction craniometric measurement revealed a 12.52% increase in the interfrontal angle. Moreover, there were increases in the bifrontal diameter, diagonal diameters, and interorbital distance. Volumetric measurements revealed an increase in the total cranial volume by 228.1 ± 110.19 cm. The anterior compartmental volume increased by 33.24%. Morphologic evaluation in the form of curvature analysis showed shrinkage of the surface area of abnormal curvature from 29.5 ± 6.71 cm preoperatively to 3.85 ± 3.66 cm after distraction.
The technique of 1-piece fronto-orbital distraction with midline splitting osteotomy but without bandeau is an effective surgical option for the treatment of metopic craniosynostosis. The postdistraction outcomes demonstrated the correction of various forms of dysmorphology in metopic craniosynostosis.
牵引成骨术在不同类型的颅缝早闭治疗中已得到广泛应用。我们旨在介绍一种用于治疗额缝早闭的单块额眶牵引技术，该技术采用中线劈开截骨术但不使用眶带，并基于三维计算机模拟，介绍使用颅骨测量、容积和形态学参数进行结果评估的方案。
这项回顾性研究纳入了9例孤立性额缝早闭患者，他们于2015年12月至2018年2月期间接受了牵引成骨术的手术矫正。截骨术设计为单块额眶牵引形式，不分离眶带并伴有中线劈开截骨术。随后应用2对颅骨牵开器以产生前外侧扩张。术前和牵引后计算机断层扫描数据的三维文件用于测量颅骨测量、容积和形态学参数。
牵引后的颅骨测量显示额间角增加了12.52%。此外，双额径、对角线直径和眶间距离均增加。容积测量显示颅骨总体积增加了228.1±110.19 cm。前颅腔容积增加了33.24%。以曲率分析形式进行的形态学评估显示，异常曲率的表面积从术前的29.5±6.71 cm缩小至牵引后的3.85±3.66 cm。
单块额眶牵引并中线劈开截骨术但不使用眶带的技术是治疗额缝早闭的一种有效手术选择。牵引后的结果表明，额缝早闭的各种形态异常得到了矫正。
