New trends in cranio-orbital and midface distraction for craniofacial dysostosis.

PURPOSE OF REVIEW: Syndromic craniofacial dysostosis remains one of the most challenging diagnoses in congenital craniomaxillofacial surgery. Distraction osteogenesis has held the promise of greater facial movements with improved stability, less morbidity and more favorable functional and esthetic outcomes. Current literature is starting to determine whether this promise is being fulfilled.

RECENT FINDINGS: The current trend in the literature is increasing indications for distraction in treating syndromic synostosis. Posterior vault, anterior vault, early monobloc and segmental Lefort distraction techniques are being advocated as alternatives to traditional surgeries. Outcome analysis of distraction techniques is becoming more common, especially in the assessment of obstructive sleep apnea and advancement stability.

SUMMARY: Distraction osteogenesis has challenged, and in many centers modified, the treatment algorithms for craniofacial dysostoses that had been based on traditional osteotomy techniques. In some cases, distraction osteogenesis has encouraged earlier, more aggressive surgeries; in others, it has served as a temporizing measure to allow subsequent traditional surgeries to be performed at a more favorable age. As craniofacial distraction osteogenesis evolves and we become more critical in our outcome analysis, we may find more favorable long-term results compared with traditional techniques in aspects such as premature aging, bone healing and degree of advancement.