Distraction osteogenesis has recently been applied to the treatment of craniosynostosis. However it has a disadvantage that the deformed bone cannot be reshaped. We performed cranioplasty by gradual distraction combined with radial osteotomy to allow for flattering of the segment of bone. Five cases with craniosynostosis were treated with distraction osteogenesis with radial osteotomy. These included scaphocephaly in three, trigonocephaly in one, and oxycephaly in one case. In the patient with scaphocephaly, pai osteotomy was performed; however osteotomized bone was not detached from underlying dura. Two distraction devices were placed in the parasagittal region bilaterally. In two patients out of three, reverse-distraction devices were applied in the removed coronal suture to reduce in anteroposterior skull length. The abnormal bossing of the frontal and occipital regions was reduced by partially radial osteotomy. In the patient with trigonocephaly, fronto-orbital osteotomy was done leavingthe bone attached to the dura. Fused metpic suture was also osteotomized. Three distraction devices were applied to the bitemporal and metpic suture regions. The frontal bone was partially remodeled with radially oriented osteotomies. In the patient with oxycepaly, the occipital bone was osteotomized and two distraction devices were applied. Radial osteotomy was performed in the occipital bone. The postoperative courses were uneventful and good cranial shapes were obtained in every case. Distraction osteogenesis offers the advantages of no need for bone graft, no residual extradural dead space, and maintenance of vascularity to the osteotomized bone through the attached dura. On the other hand, drawbacks of the technique include the inability to remodel the deformed bone and the necessity of the additional operatin to remove the distraction device. We think distraction combined with radial osteotomy could improve the former drawback by remodeling deformed bone.
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