Cranial Vault Distraction Method

In patients with craniofacial syndromes, the skeletal discrepancy is often severe, and the ability to achieve the desired movement by immediate surgical repositioning is difficult because of restrictions of the soft-tissue envelope. The technique of distraction osteogenesis has provided an additional option for managing congenital and acquired craniofacial deformities. The use of distraction osteogenesis is, however, still within its infancy as a treatment modality. It is unlikely that the procedure will obviate the need for definitive orthognathic surgery at skeletal maturity in most patients with craniofacial anomalies. The role of distraction osteogenesis in craniofacial surgery will continue to evolve rapidly with increasing experience and technological advancement. Because distraction osteogenesis in the facial skeleton is a relatively new approach, analysis of the contemporary literature is imperative, and future long-term studies on the effects and outcome of distraction are essential.

Cranial vault expansion by distraction osteogenesis has the great advantage, as the name implies, of generating new and vascularized autologous bone of the correct shape and in correct locations. The technique, al- though not simple and not risk free, is much less technically complicated and places patients at lower risk for the most serious complications than does single-stage vault expansion. Less soft tissue dissection and less devascularization of bone are required and there are no postoperative dead spaces. Distraction osteogenesis facilitates far greater vault expansions than do single-stage procedures and can be accomplished in any desired direction. (J Neurosurg Pediatrics 7:035010–030610, 2011)

With distraction devices, the time required for the surgery could be shortened almost 3 1/3 h; the bleeding during the surgery was decreased with reduced requirement of more than 200 ml of blood transfusion as compared with remodeling surgery. Postoperatively achieved distraction distances varied from 30.0 to 47.5 mm (mean, 42.99 mm). The average increased volume percent of cranium in distraction surgery group was 20.9% (range, -11.5 to 58.9%) after full distraction.
With distraction surgery, satisfactory cranial volume expansion and aesthetically pleasing morphological states were achieved in all cases, and the efficacy was statistically significantly high as compared with remodeling method. (Childs Nerv Syst. 2007 Feb;23(2):201-6. Epub 2006 Oct 13.)