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Distraction Osteogenesis Versus Conventional Fronto-Orbital Advancement for the Treatment of Unilateral Coronal Synostosis: A Comparison of Perioperative Morbidity and Short-Term Outcomes

Tahiri, Youssef MD, MSc*; Swanson, Jordan W. MD; Taylor, Jesse A. MD

doi: 10.1097/SCS.0000000000002020
Original Articles

Fronto-orbital advancement and remodeling (FOAR) remains the most widely practiced treatment of unicoronal craniosynostosis (UCS) despite recent studies of ocular dysfunction and aesthetic shortcomings in the long-term. The aim of the study was to compare perioperative morbidity and short-term outcomes of a recently developed, nondevascularizing, distraction-based treatment of UCS with conventional FOAR. To do so, the authors compared the first 6 patients who were treated with a new osteotomy/distraction approach to the last 6 patients who underwent traditional FOAR for the treatment of UCS with regards to demographics, operative details, perioperative morbidity, and short-term outcomes.

Between July 2012 and June 2014, 6 patients underwent each procedure. Duration of surgery and length of hospital stay in the distraction group were on average 2 hours 7 minutes and 3.4 days, respectively, significantly less than in the traditional FOAR group (P = 0.039, P = 0.032, respectively). Perioperative blood loss averaged 169 mL, which trended toward less than in the traditional group (mean of 400 mL, P = 0.065). Patients undergoing conventional compared with distraction osteogenesis-mediated FOAR were significantly more likely to develop new-onset strabismus postoperatively (odds ratio 15.4; P = 0.0384). All 12 patients completed therapy without complications and with Whitaker grade I results at latest follow-up.

In the perioperative period, distraction-mediated cranial vault remodeling provides similar correction of the aesthetic deformity associated with UCS and an improved morbidity profile. Longer follow-up is needed to determine how distraction compares with FOAR with respect to neuropsychologic and long-term aesthetic outcomes.

*Riley Hospital for Children, Indiana University, IN

Division of Plastic Surgery

Division of Plastic Surgery, The Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, PA.

Address correspondence and reprint requests to Jesse A. Taylor, MD, The Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Colket Translational Research Building, 3501 Civic Center Blvd, 9th Floor, Philadelphia, PA 19104; E-mail:

Received 11 February, 2015

Accepted 19 August, 2015

This study was reviewed and approved by the institutional review board of the Children's Hospital of Philadelphia.

This study was funded by the Department of Surgery of The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania.

The authors report no conflicts of interest.

© 2015 by Mutaz B. Habal, MD.