{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:16:27Z","timestamp":1788243387153,"version":"build-2803163510"},"reference-count":35,"publisher":"Korean Cleft Palate-Craniofacial Association","issue":"4","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["e-acfs.org"],"crossmark-restriction":true},"short-container-title":["Arch Craniofac Surg"],"published-print":{"date-parts":[[2026,8,20]]},"abstract":"<jats:p>Non-syndromic craniosynostosis is the most common clinical form of craniosynostosis, but the mature phenotype cannot be accounted for by a purely local model of premature suture fusion. The deformity is the product of interactions among calvarial growth, cranial base geometry, dural and mesenchymal signaling, orbital development, and regional soft-tissue adaptation. This narrative review examines current evidence on epidemiology, developmental biology, diagnosis, imaging, operative timing, and surgical management, with emphasis on systematic reviews, multicenter and population-based data, comparative cohorts, and larger independent series. Contemporary options\u2014conventional cranial vault remodeling, fronto-orbital advancement and remodeling, endoscope-assisted suturectomy with postoperative orthotic therapy, spring-assisted techniques, and distraction osteogenesis\u2014each occupy a legitimate place in selected age groups and phenotypes. This review gives particular attention to distraction because of its potential for individualized, three-dimensional correction: it is the approach in which vector, magnitude, and regional expansion can be adjusted while new bone forms and the surrounding soft-tissue envelope adapts, which is precisely what a three-dimensional deformity demands. Current comparative evidence does not establish superiority for every subtype, but the biologic rationale and available clinical results justify a broader role for distraction in contemporary reconstruction. Osteotomy design and vector geometry should follow the dominant phenotype: transverse expansion when biparietal restriction predominates in sagittal synostosis; multivector correction when orbital, skull-base, or posterior vault distortion is established; and a higher operative threshold in metopic synostosis, where true fronto-orbital narrowing\u2014not suture fusion alone\u2014should drive the decision. Outcomes should be judged by deformity-specific three-dimensional balance, functional safety, treatment burden, and long-term stability, and not by a single cranial index.<\/jats:p>","DOI":"10.7181\/acfs.2026.0127","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:41:18Z","timestamp":1787895678000},"page":"163-172","update-policy":"https:\/\/doi.org\/10.7181\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Non-syndromic craniosynostosis: contemporary concepts in biology, diagnosis, and distraction-based operative strategy"],"prefix":"10.7181","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6638-4110","authenticated-orcid":true,"given":"Wooyeol","family":"Baek","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea"},{"name":"Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, 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