**1. Introduction**

Syndromic craniosynostosis is a condition which involves premature fusion of multiple skull sutures and may be associated with extracranial deformities such as limb, cardiac and tracheal malformations [1, 2]. Therefore, this syndrome usually comes with related issues such as increased intracranial pressure which can cause visual impairment (increased intraocular pressure), sleep impairment and eating difficulties due to midface hypoplasia, and even risk of impairment of mental development [3]. There are about 150 syndromes associated with craniosynostosis namely Crouzon, Pfeiffer and Apert syndrome.

Therefore, corrective surgery in syndromic craniosynostosis were developed in relation to its deformities and functional issues. Conventional craniofacial surgical techniques, such as strip craniectomy, fronto-orbital advancement, and Le Fort III procedures proved to be reliable to treat symptomatic syndromic craniosynostosis. However, limitations were observed in severe conditions where large segmental advancement were required, difficulty to close the gap primarily as well as inadequate stability secondary to soft tissue restriction and unstable bone segment fixation. These limitations thus causing relapse and creating less than an ideal long-term outcome [4]. Hence distraction osteogenesis (DO) were introduced to provide a reliable surgical alternative in achieving superior segmental advancement compared with conventional techniques in treating functional issues in syndromic craniosynostosis.

Syndromic craniosynostosis patients usually presented with multiple major functional disturbances which requires multi-disciplinary management including maxillofacial surgery, neurosurgery, plastic surgery and ENT among others. As such, the indication for each major surgery in paediatric patients with this condition should be discussed by the craniofacial team members as the procedure carries substantial mortality and morbidity risks [5].
