Reossification of Cranium and Zygomatic Arch After Monobloc Frontofacial Distraction Advancement for Syndromic Craniosynostosis

Abstract

Monobloc frontofacial advancement with distraction is becoming more routinely used within craniofacial surgery for faciocraniosynostosis, because of the simultaneous correction obtained on the exorbitism and of the respiratory impairment. Reossification of the cranium and zygomatic bone in monobloc frontofacial advancement with distraction has not been assessed previously on long series. In this study, 40 patients, 22 Crouzon, 11 Apert, and 7 Pfeiffer syndrome who underwent a frontofacial monobloc advancement by distraction osteogenesis, were retrospectively reviewed, after a mean of 2.1 years of follow-up. The bone linkage between both margin of the coronal and zygomatic osteotomy gap was evaluated on three-dimensional computed tomographic scan postoperatively. The correlations between reossification and some clinical situations (diagnosis, existence of previous anterior craniofacial procedure, use of bone paste, and the age at operation) were studied to determine factors that influence on reossification. "Good" or "fair" reossification on coronal gap was demonstrated by 68.2% of those with Crouzon and 54.5% of those with Apert syndrome. In contrast, 85.7% of those with Pfeiffer syndrome had "poor" or "absent" reossification. Rebridging of the zygomatic arch in Pfeiffer was also the poorest among 3 syndromes. Previous operations performed before the frontofacial monobloc advancement decreased reossification of distraction gap. In the group of patients in whom autologous bone paste on coronal osteotomy gap was applied, the bone formation was improved in all syndromes significantly. The reossification of the coronal osteotomy gap in patients with Pfeiffer syndrome is poor compared with those with Crouzon and Apert syndromes. Bone paste is extremely effective on increasing osteogenesis even in patients with Pfeiffer syndrome or the patients with previous surgery.