頭蓋骨縫合早期癒合症に対する骨延長法を用いた頭蓋拡大形成術

Distraction Osteogenesis for Craniosynostosis

Point

・骨延長法は複数回の手術が必要であるが，頭皮をゆっくり引き伸ばすことで十分な頭蓋拡大が得られる．

・FOA手術のポイントは眼窩上縁骨の骨切りであるが，線鋸を用いることで安全かつ簡便に骨切りが行える．

・BPE手術では，頭蓋底に近い部分まで骨切りを行うことで，頭蓋容積を十分に増大させることが可能となる．

　Distraction osteogenesis is the standard surgical procedure for cranioplasty in children over 6 months of age. This technique carries a risk of detachment of the extender and infection during the course, but such troubles can be reduced by accumulating surgical experience. In addition, furing distraction osteogenesis, the cranium can be sufficiently expanded by slowly stretching the scalp, while adjustment ensures that the facial appearance does not change too much. In this paper, I will explain the surgical technique and postoperative management, focusing on FOA（Fronto-orbital advancement）for trigonocephaly or brachycephaly and BPE（Bilateral parietal expansion）for scaphocephaly. The point of surgery in FOA is the osteotomy of the orbital bar. The osteotomy can be performed safely and easily using a wire saw. The aim of surgery in BPE is to extend an osteotomy up to the front of the coronal suture and down to the part near the cranial floor. This allows improvements of the cranial shape while sufficiently increasing the cranial volume.