Reconstruction Procedures in Adult Craniosynostosis Patients

Patients with syndromic and nonsyndromic synostosis may have end-stage skeletal discrepancies involving the skull, the lower midface, and the mandible, with associated malocclusion. Repeat surgery for craniosynostosis during long-term follow-up is common, especially in syndromic patients. The severity of skull deformity and early initial surgery may be important factors for subsequent need for repeat surgery. The manifest midfacial hypoplasia is often treated by craniofacial or midfacial advancements with different distractor systems and the benefits of midfacial advancement by distraction osteogenesis are well recognized. While surgical procedures in this population can be reliably executed, the surgeon must be aware of the unique morphologic characteristics that accompany the primary diagnoses. One major problem in distraction osteogenesis for adult craniosynostosis patients is the fact that distances that need to be balanced vary considerably across levels (frontal, nasal, orbital, and maxillary). Thus, in the frontal area, the extent of the forward displacement is commonly less than in the orbital and nasal areas, while in the midfacial area, in particular at the level of the occlusal plane, it is larger. New reconstruction strategies combine osteotomies with bone augmentation to overcome the leveling problem. The combined midfacial distraction and bone augmentation approach enables to assess the different distances of the three-dimensional displacements of the individual parts of the skull.