Rigid fixation and osteotomy design in frontal orbital advancement osteotomies

The advantages rendered by corrective osteotomies that mobilize large segments of the craniofacial complex, including the forehead, orbits, and maxillae, exceed those of any partial correction in this particular region. This fact has been fully demonstrated in recent years by different authors. An inconvenience of early correction of major craniofacial deformities is relapse at the maxillary level, mainly because of the lack of adequate dental occlusion. Rigid fixation methods have been used in surgical correction of Crouzon's disease and Apert's syndrome in order to preserve the position of the mobilized segments. In Crouzon's cases conventional monoblock advancements were performed, using anchor wire osteosynthesis at the frontal region and two metal plates attached to the temporal bone to support the middle third of the face. In Apert's syndrome cases, a monoblock advancement modified by the facial bipartition concept was the selected procedure to obtain a three-dimensional correction. Because a midfacial vertical elongation was necessary, a third plate joins the hemi faces, fixing them to the intermediate frontal bar. Advantages of this method have been demonstrated over the past 2 years. Sixteen children had a one-stage reconstruction by multiple osteotomies and extensive, combined mobilizations of the craniofacial complex. Successful long-lasting corrections attest to the efficacy of this fixation method.