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Advancement-onlay: an improved technique of fronto-orbital remodeling in craniosynostosis
S R Cohen1, H K Kawamoto, F Burstein
1Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor 48109-0340.
Insights
This study evaluated fronto-orbital remodeling using an advancement-onlay technique in 18 infants with craniosynostosis. The technique demonstrated good to excellent surgical outcomes in 94% of cases, with minimal complications and no observed growth disturbances.
Area of Science:
- Plastic Surgery
- Craniofacial Surgery
- Pediatric Neurosurgery
Background:
- Nonsyndromic craniosynostosis requires surgical correction to address abnormal skull shape.
- Fronto-orbital remodeling is a common surgical approach for these conditions.
- Advancements in surgical techniques aim to improve outcomes and minimize complications.
Purpose of the Study:
- To evaluate the efficacy and safety of the advancement-onlay technique for fronto-orbital remodeling in infants with nonsyndromic craniosynostosis.
- To assess surgical outcomes, complications, and long-term growth following this specific surgical method.
Main Methods:
- Retrospective analysis of 18 infants with nonsyndromic craniosynostosis undergoing fronto-orbital remodeling.
- The advancement-onlay technique involved craniotomy, superior orbital rim recontouring/advancement, and frontal bone graft rotation/onlay.
- Rigid fixation with microplates and screws was used for anterior fixation, replacing traditional wire osteosynthesis.
Main Results:
- Good to excellent surgical results were achieved in 94% of patients.
- No serious postoperative complications were reported.
- Minor issues like forehead recession (17%) or contour abnormalities (5 cases) were observed, with no significant growth disturbances or resynostosis.
Conclusions:
- The advancement-onlay technique with rigid fixation is a safe and effective method for fronto-orbital remodeling in infants with craniosynostosis.
- The technique yields high rates of satisfactory aesthetic and functional outcomes.
- Long-term craniofacial growth appears unaffected by this surgical approach.
Abstract:
Eighteen patients with nonsyndromic craniosynostosis underwent fronto-orbital remodeling with an advancement-onlay technique. The mean age of the infants was 5 months (range = 2-11 months) when the procedure was performed for the following indications: unilateral coronal synostosis (n = 10); bilateral coronal synostosis (n = 3); metopic synostosis (n = 2); and multiple craniosynostoses (n = 3). The technique consists of (1) unilateral or bifrontal craniotomy, (2) superior orbital rim recontouring and advancement, and (3) frontal bone graft rotation and onlay. Posteriorly, the frontal bone graft is left "floating," while anteriorly, rigid fixation with microplates and screws has supplanted wire osteosynthesis. The use of rigid fixation prevents uncontrolled "float" of the forehead and eliminates the need for temporal struts. Follow-up time ranged from 6 to 60 months (mean = 2.6 years). There were no serious postoperative complications. Surgical results were good to excellent in 94% of cases and poor to fair in 6%. Only 1 patient with a Kleeblattschädel deformity required major revision, while another patient with trigonocephaly underwent a minor, extracranial recontouring procedure. Supraorbital rim and/or forehead recession suggestive of relapse or initial inadequacy of anterior projection occurred in 3 patients (17%). Residual, mild contour abnormalities of the forehead and/or temporal regions were found in 5 cases. To date, no gross disturbances in craniofacial growth related to our method of rigid fixation have been observed and no clinically detectable resynostosis has occurred.