KẾT QUẢ PHẪU THUẬT TẠO HÌNH KÉO GIÃN PHỨC HỢP TRÁN Ổ MẮT ĐIỀU TRỊ DÍNH KHỚP TRÁN ĐỈNH MỘT BÊN

Abstract

FOD is a gradual, controlled correction of fronto-orbital deformities, which provides better improvement for the craniofacial asymmetry compared to other traditional techniques. Objective: This study aimed to evaluate the surgical outcomes of Fronto-Orbital Distraction (FOD) for the treatment of premature unilateral coronal synostosis in children. Methods: A retrospective, descriptive study was conducted on 11 patients diagnosed with isolated unilateral coronal synostosis, corrected with fronto-orbital distraction method at the Craniofacial and Plastic Surgery Department, National Children's Hospital from 2022 to 2024. All patients underwent 3D CT scanning at 3 times: pre-surgery, distraction device removal, and 1-year visit. A single distraction device was placed horizontally across the prematurely fused suture after osteotomy at the 10 o'clock position. Distraction rotation was performed from 2 days after surgery, twice per day, at a rate of 1 mm per day. Distraction rotation was stopped when the distraction reached 30mm, and the device was removed after 3 months. Surgical outcomes, facial symmetry, orbital morphology, and cranial base were evaluated. Results: Fronto-orbital distraction with a modified osteotomy technique was performed on 11 patients with unilateral coronal synostosis. The mean age at surgery was 6.2 ± 3.1 months, 45.4% showed signs of increased intracranial pressure, the mean operative time was 119.8 ± 25.5 minutes. One-year follow-up showed superior improvement in all aspects regarding frontal disproportion, volume discrepancy, and asymmetry in the orbital, nasal, and sphenoid regions after FOD. The disparity in the fronto-orbital-nasal angle improved: reduced to 1.5 ± 1.2 degrees compared to 8.7 ± 2.1 degrees before surgery, and remained stable at 1.2 ± 0.8 degree upon device removal. During the follow-up period, all patients were satisfied with the aesthetic and functional results. No remarkable complications noted, one case of dural tear was immediately managed with suture repair. Conclusion: Fronto-orbital distraction (FOD) surgery yields good, aesthetically and functionally sustainable results, significantly improves the symmetry of the frontal, orbital, and craniofacial regions. This is a feasible, safe, effective, and minimally invasive procedure that might be preferred for the treatment of unilateral coronal synostosis. It should only be applied in craniomaxillofacial surgical centers with comprehensive expertise, excellent surgical anesthesia and resuscitation capabilities, and well-trained surgeons.