Related Experiment Video
Updated: Jun 12, 2025
Treatment of Facial Deformities using 3D Planning and Printing of Patient-Specific Implants
Published on: May 23, 2020
Frontal Bone Resorption after Frontofacial Monobloc Advancement in FGFR -Related Craniosynostoses: Predictive Factors
Matthieu Landart1,2, Sandro Benichi1,2, Syril James1,2,3
1From the Departments of Neurosurgery.
Background:
Frontofacial monobloc advancement (FFMBA) with internal distraction is a key procedure in managing FGFR -related craniosynostoses. Resorption of the frontal bone flap can occur months to years postoperatively. This study aimed to identify clinical factors associated with the extent of frontal bone resorption in patients with Crouzon or Pfeiffer syndrome.
Methods:
A retrospective single-center study was conducted on children with Crouzon or Pfeiffer syndrome who underwent FFMBA between May of 2008 and October of 2021. Computed tomography scans were analyzed at 4 points in time: early postoperatively (before distraction), at the end of distraction, 2 years after surgery, and, optionally, 5 years after surgery. Variables examined included demographic data, genetic mutation, prior craniofacial procedures, presence of tracheostomy or ventriculoperitoneal shunt, indication for FFMBA, perioperative parameters (osteosynthesis type, advancement, or surgery duration), and postoperative parameters (cerebrospinal fluid leak, infection, distraction protocol, or retrofrontal dead space).
Results:
A total of 63 patients were included (mean age, 2.91 ± 1.61 years). At 2 years postoperatively, the mean frontal bone resorption was 4.83 ± 5.35 cm² (range, 0 to 27.3 cm²). Significant factors associated with increased resorption included use of absorbable sutures compared to steel wires (9.83 versus 3.99 cm²; P = 0.04) and the presence of a retrofrontal dead space at 2 years (13.12 versus 3.63 cm²; P < 0.001).
Conclusions:
Frontal bone resorption following FFMBA is significantly associated with the use of absorbable sutures and persistent retrofrontal dead space. Rigid osteosynthesis should be favored, and distractor activation should be performed with follow-up of brain expansion.
Clinical Question/Level Of Evidence:
Risk, III.
Related Concept Videos
01:22Sutures of the Skull
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
01:14Cranial Bones: Superior and Posterior View
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...
01:27Cranial Bones: Lateral View
The temporal bone forms the lower lateral side of the skull. The temporal bone is subdivided into several regions. The flattened upper portion is the squamous portion of the temporal bone. Below this area and projecting anteriorly is the zygomatic process of the temporal bone, which forms the posterior portion of the zygomatic arch. Posteriorly is the mastoid portion of the temporal bone. Projecting...