Distraction osteogenesis in the surgical treatment of craniostenosis: a comparison of internal and external craniofacial distractor devices

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To compare the practical difficulties of external and internal craniofacial distraction devices used in craniofacial advancement in terms of technical surgical limitations and patients' discomfort. This study involved analysis of the pertinent literature and personal experience on the treatment of patients affected with syndromic craniosynostoses treated with craniofacial distraction advancement. One hundred patients who underwent internal craniofacial distraction were analyzed. This kind of distraction device was found to be adequately tolerated by the patients with regards to physical and psychological aspects. They had relatively little impact on day-life activities. However, a significant drawback of this type of device is represented by the difficulty in controlling the vectors of distraction. Thirty-eight patients were analyzed after having received the implantation of an external craniofacial distraction device. This type of instrumentation was found to have a significant psychological impact and important limitation on recreational activities. External devices, however, offered important advantages in the control of the vectors of distraction, which could be modified according to the patient's needs during the perioperative and early postoperative clinical course. There were no significant differences among the two types of devices with regard to osteogenesis and degree of facial advancement. Both internal and external devices are effective in distraction craniofacial advancement. However, significant differences do exist concerning the surgical aspects and the practical difficulties experienced by the patients.