Gradual cranial vault expansion for the treatment of craniofacial synostosis: a preliminary report.

To treat craniosynostosis, skull reshaping (such as fronto-orbital advancement) is widely performed. Surgical techniques have improved, however several problems still remain, such as postoperative relapse, late resorption, and infection. The main reason for this is probably (1) that the "craniotomized" bone for changing skull contour is used as free bone grafts and (2) that dead space between the reshaped bone and dura is created. We have developed a new method in which cranial bone is expanded gradually, together with the dura, using expansion devices. With this approach there is no extradural dead space postoperatively and the cranial bone segment remains vascularized. We have performed this procedure in 2 patients with Crouzon's disease and in 1 patient with sagittal synostosis. In the Crouzon's patients, osteotomies were performed to form a one-piece fronto-orbital bony complex without detaching the bone from the dura, and three expansion devices were applied. In the patient with sagittal synostosis, bilateral temporoparietal osteotomies were done in the same fashion and two expansion devices were applied. Expansion was started on the fourth postoperative day at a rate of about 1 mm per day. After obtaining the proper expansion, the devices were removed and the bone segments were fixed with miniplates and screws. All patients showed good results without any complications.