Skeletal Improvement and Stability of Craniofacial Distraction in Syndromic Craniosynostosis

摘要

The purpose of the study is to evaluate the skeletal improvement and stability after forward craniofacial distraction in patients with syndromic craniosynostosis. There were eight patients (6 Crouzon's, one Apert's and one Pfieffer's), age ranged from 4.8 to 18.4 years. The osteotomies of 6 monobloc and 2 Le Fort III were performed for forward distraction with rigid external distraction device. Serial lateral cephalometric radiographs were traced and superimposed to evaluate the progression, outcome and stability with one to 4.5 years of observation. The results indicated the symptoms relief and profile improvement after distraction. The N point was moved forward by 10 mm in monobloc distraction. The average advancement increased gradually from orbitale, ANS to A point reaching to 20 mm. These landmarks demonstrated downward and limited forward growth in follow up. The N point presented continued forward movement by bone remodeling. In conclusion, the pace of distraction could be adjusted in each vertical level of distraction to titrate the changes of facial profile for individual needs. Further adjunctive orthognathic or nasal surgery might be needed to improve the profile, symmetry, mandible position and good dental occlusion.