Fronto-orbital advancement by distraction: the latest modification.

In 1996 the authors performed the first fronto-orbital advancement by distraction osteogenesis in a patient with coronal synostosis, and they have refined the surgical technique since then. Their latest technique has the following features: 1) the osteotomy lines are almost identical to those of conventional fronto-orbital advancement except for the lack of supraorbital osteotomy and tongue-in-groove osteotomy; 2) burr holes are placed at the pterion just behind the sphenoid wing and at the bregma lateral to the anterior fontanel bilaterally, and another burr hole is placed on the glabella 1 cm above the nasion; 3) to gain access to the lateral portion of the anterior cranial base, a 7- to 10-mm-wide segment of bone is removed at the pterion using rongeurs; 4) the sphenoid ridge is widely removed; and 5) osteotomy is performed using a Gigli saw and rongeurs. They report their latest technique.