In 1996 the authors performed the first fronto-orbital advancement by distraction osteogenesis in a patient with coronal synostosis, and they have refined the surgical technique since then. Their latest technique has the following features: 1) the osteotomy lines are almost identical to those of conventional fronto-orbital advancement except for the lack of supraorbital osteotomy and tongue-in-groove osteotomy; 2) burr holes are placed at the pterion just behind the sphenoid wing and at the bregma lateral to the anterior fontanel bilaterally, and another burr hole is placed on the glabella 1 cm above the nasion; 3) to gain access to the lateral portion of the anterior cranial base, a 7- to 10-mm-wide segment of bone is removed at the pterion using rongeurs; 4) the sphenoid ridge is widely removed; and 5) osteotomy is performed using a Gigli saw and rongeurs. They report their latest technique.
The authors' technique for correction of coronal synostosis by distraction osteogenesis is modified by eliminating the supraorbital osteotomy, moving the burr holes, rongeuring bone at the pterion, widely removing the sphenoid ridge, and performing the osteotomy with Gigli saw and rongeurs.
*Division of Plastic and Reconstructive Surgery, Teikyo University School of Medicine, Tokyo; the †Division of Plastic and Reconstructive Surgery, Jichi Medical School, Tochigi; the ‡Department of Plastic Surgery, Faculty of Medicine, Tokyo University; and the §Department of Neurosurgery, Fukushima Medical School, Japan.
Received Nov 19, 2001, and
in revised form Mar 5, 2002.
Accepted for publication Mar 5, 2002.
Address correspondence and reprint requests to Dr Hirabayashi, Division of Plastic and Reconstructive Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashiku, Tokyo, Japan.
Hirabayashi S, Sugawara Y, Sakurai A, Tachi M, Harii K, Sato S. Fronto-orbital advancement by distraction: the latest modification.