The International State of Cranial Distraction Osteogenesis: A Survey of the International Society of Craniofacial Surgery

Background: Distraction osteogenesis (DO) is widely used in the treatment of craniosynostosis, yet international standards for best practices remain lacking. This study aimed to characterize global practice patterns in cranial DO, including surgical timing, techniques, imaging use, and surgeon-specific preferences. Methods: A 38-question survey was distributed to 339 active members of the International Society of Craniofacial Surgery. Survey variables included country of practice, years in practice, indications for use of DO, imaging practices, perceived challenges, adoption of new technologies, and timing for latency, distraction, and consolidation phases. Responses were analyzed using descriptive statistics, stratified by continent, years in practice, and national healthcare resource availability. Results: Sixty-four surgeons from 22 countries responded (18.9% response rate); 96.9% reported using DO. DO was most often used in syndromic (90.3%) and multisuture (83.8%), followed by unilateral coronal (25.8%), lambdoid (25.8%), and sagittal craniosynostosis (16.1%). Surgeons with <5 years of experience favored shorter latency periods (1.81.3-days), while those with >20 years of experience preferred longer latency periods (4.52.1-days). Average distraction rate was 1.2 mm per day. Bone quality was the most frequent factor influencing distraction rate. The average consolidation period was 8.1 weeks and length was most influenced by patient age. Conclusion: Substantial global variation exists in cranial DO protocols, particularly in latency, distraction rate, and consolidation timing. Preferences appear to be surgeon-specific and influenced by years of clinical practice and location. As innovations continue to shape practices, additional research will be necessary to establish consensus and best practices for optimal patient care.