Consolidation Time and Relapse: A Systematic Review of Outcomes in Internal versus External Midface Distraction for Syndromic Craniosynostosis
Bibliographic record
Abstract
BACKGROUND: The choice between internal and external distraction osteogenesis for midface advancement in patients with syndromic craniosynostosis is based primarily on surgeon preference and expertise. However, differences in outcomes between the two techniques have been sparingly compared. In this work, the authors performed a systematic review to compare outcomes between internal versus external midface distraction. METHODS: A systematic review was performed of studies published between 1998 and 2018 (61 studies included; n = 689 patients). Operative characteristics, early reoperations, complications, and relapse rates were extracted. Bias evaluation was performed using the Newcastle-Ottawa instrument. Statistical analyses were performed with independent samples t tests and linear regression analyses (p < 0.05 considered significant). RESULTS: The authors found that external distraction was associated with more Le Fort III osteotomies and hardware adjustments (p = 0.023), whereas internal distraction was associated with more monobloc osteotomies and longer consolidation times (p = 0.008). No significant differences in the distance of midface advancement, reoperations, complications, or relapse rates were noted between internal versus external distraction, although external distraction trended toward a slightly higher relapse rate. Regardless of distraction protocol, consolidation time was found to be a strong negative predictor for relapse (beta = -0.792; p = 0.02). CONCLUSIONS: No significant differences were demonstrated in advancement distance, reoperative rates, complication rates, or relapse rates for internal versus external distraction for midface advancement. Regardless of distraction type, consolidation time was strongly inversely associated with relapse rates. The trend toward higher relapse in external distraction is potentially explained by the significantly lower consolidation times.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.043 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.011 |
| Bibliometrics | 0.009 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".