Distraction osteogenesis (DO) has gained popularity as a reliable method for expanding cranial volume and improving cranial shape in patients with craniosynostosis (Choi et al., 2010; Derderian et al., 2015). One-piece fronto-orbital distraction, which distracts the frontal and orbital bones without creating a bandeau, has been successfully applied to address coronal suture synostosis (Bradley et al., 2006; Jeong et al., 2016).

One-piece fronto-orbital DO has several advantages compared to conventional cranial vault remodeling. As fronto-orbital DO gradually expands the skull and overlying scalp, it can concomitantly decrease soft tissue resistance and relapse (Choi et al., 2015). Nevertheless, DO requires a two-stage operation, and diverse device-related complications can be encountered during the distraction period. If the distraction protocol can be accelerated without bony relapse, it can minimize patient discomfort during distraction and the risk of distractor-related complications (Yonehara et al., 2003).

The osteogenic process of the cranium differs from that of long bones owing to its membranous and non−weight-bearing characteristics. The supporting dura mater also increases the cranial bone regeneration capacity. Therefore, DO in fronto-orbital advancement has the potential to allow an accelerated distraction protocol (ADP) without compromising stability. This study aimed to assess the bony relapse ratios of the standard protocol (SP) and the ADP by quantitatively analyzing the cranial volume changes and comparing the complication rates during the distraction period.