Craniofacial distraction osteogenesis en bloc

Bone distraction of the superior and medial thirds of the craniofacial skel eton en bloc, avoiding a frontal craniectomy is presented. We applied this procedure in eight patients who were more than 5 years old with different t ypes of craniofacial synostosis and who had not received previous treatment , and with a normal frontal shape. During monobloc advancement, major compl ications were encountered in older patients, especially the impossibility o f the brain to expand rapidly to fill the retrofrontal dead space. Distract ion osteogenesis of the craniofacial skeleton en bloc (without craniectomy) is feasible. Miniplates and screws are avoided as well as the possibility of frontal relapse or fractures of the frontozygomatic region. The patients did not need skull vault remodeling, except for a small cranioplasty at th e bregma zone. The results obtained were satisfactory and stable at the tim e. This procedure avoids any kind of osteosynthesis, there is no extradural dead space, the operative time is brief, and blood loss is minimal. The in convenience is the necessity of a second operation to remove the distracter .