Bridging the Frontozygomatic Gap in Fronto-Orbital Advancement Using Autologous Bone Bead Grafts, a Technical Note

Fronto-orbital advancement is a standard surgical technique for addressing late-presenting craniosynostosis, particularly in cases involving premature fusion of the metopic or coronal suture. Inherently, this procedure results in a gap at the frontozygomatic pillar due to the advancement of the supraorbital bandeau, which presents a unique challenge for bone grafting because of its limited dimensions and the fact that the bone needs to be kept in a stable position. This technical note introduces a flexible and efficient approach to bridging this gap using autologous bone bead grafts. These grafts are secured with monofilament resorbable sutures, anchoring them to the lower portion of the frontozygomatic pillar and the advanced zygomatic process of the bandeau. This technique not only simplifies the grafting of the gap but also enhances the stability of the advanced bandeau. Furthermore, the use of virtual surgical planning can improve efficiency and predictability by enabling precise assessment of the gap at the frontozygomatic region and accurate estimation of the required combined volume of the bone beads.