Unilateral coronal synostosis treated by internal forehead distraction

A 1-year-old infant with left hemicoronal synostosis was treated by distrac tion osteogenesis of the craniofacial skeleton using an internal distractio n device. Surgery was performed through a coronal incision. The frontal bon e and upper half of both orbits were first osteotomized en bloc after minim al epidural dissection of the supraorbital area and no epidural dissection around the coronal osteotomy site. The lateral one fourth of the frontal bo ne, including the right lateral half of the orbit, was left intact. The int ernal distraction device was fixed in the left temporal area. A 0.5-mm per day rate of distraction was performed up to an elongation of 17 mm after a 5-day latency period. The distraction device was removed after a consolidat ion period of 2 months. The results obtained were satisfactory, with symmet ry of the forehead, orbit, and nose achieved without complications. The mer its of this procedure are no extradural dead space after the operation (whi ch prevents infection), shortened operative time, reduced blood loss, filli ng in the bone gap created by advancement with new bone, acceptable cosmesi s by the parents during distraction, and no fixation device left after the second operation.