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A Novel Craniofacial Osteogenesis Distraction System Enabling Control of Distraction Distance and Vector for the Treatment of Syndromic Craniosynostosis

Kobayashi, Shinji MD*; Nishiouri, Takeshi MD*; Maegawa, Jiro MD; Hirakawa, Takashi DDS; Fukawa, Toshihiko DDS§

Journal of Craniofacial Surgery: March 2012 - Volume 23 - Issue 2 - p 422–425
doi: 10.1097/SCS.0b013e3182413dec
Original Articles

Background Distraction osteogenesis is now an important clinical tool in craniofacial surgery. However, controlling the distance and vector of distraction in infants with syndromic craniosynostosis with good repeatability is a task that still proves difficult today. We have developed a new facial osteogenesis distraction system that combines the advantages of external and internal distraction devices to enable control of both the distraction distance and vector. This article describes the method and short-term results of this system.

Methods Our distraction system uses both a conventional external distraction device and a newly developed internal distraction device. Postoperative control of the distraction vector is performed using the external device, whereas control of distraction distance is done with the adjustable-angle internal device. This system was used for 2 patients with Crouzon syndrome.

Results The system enabled control of lengthening distance and vector, and no complications occurred during the procedures.

Conclusions We developed a facial distraction system leveraging the advantages of external and internal distraction devices, which we then used to successfully control both lengthening distance and vector. The system would be particularly indicated in patients with severe scarring due to multiple follow-up surgeries and in patients requiring distraction of 20 mm or more.

 Aligning the periorbital profile at 5 to 6 years old caused the maxilla to rotate counterclockwise, and we consider that a procedure combining Le Fort III osteotomy with Le Fort I and II osteotomies is required to prevent these rotations.

From the *Department of Plastic and Reconstructive Surgery, Kanagawa Children’s Medical Center, Yokohama, Kanagawa; †Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Kanagawa; ‡Hirakawa Orthodontic Clinic, Hirakawa; and §Fukawa Orthodontic Clinic, Fukawa, Japan.

Received June 23, 2011.

Accepted for publication August 6, 2011.

Address correspondence and reprint requests to Shinji Kobayashi, MD, Kanagawa Children’s Medical Center, Department of Plastic and Reconstructive Surgery, Mutsukawa 2-138-4, Minami-ku, Yokohama, Kanagawa 232-8555, Japan; E-mail:

This work was supported by Health and Labour Sciences Research Grants Research on intractable disease (No. 2011-164).

The authors report no conflicts of interest.

© 2012 Mutaz B. Habal, MD