[Compatibility between primary cranial surgery and secondary cranio-facial surgery (author's transl)]

Craniofacial surgery can radically correct the most severe dysmorphias of fronto nasal encephaloceles, trigonocephaly, plagiocephaly, telorbitism, Crouzon, Apert, Chotzen... Its procedures can make to normal their general morphology, the projection of the mid face and maxilla, centering and inter relationship of the orbital cavities. It can also correct or improve many dysfunctions such as : naso-pharyngeal atresia, dental malocclusion, exorbitism, exotropia and, consequently, strabismus. According to syndromes and degree of severity, craniofacial surgery is undertaken between 2 to 10 years of age. This surgery is both cranial and facial, it uses or passes through the "orbito frontal bandeau" : glabella (frontal sinus), orbital roof, supra-orbital ridges down to the fronto-zygomatic sutures. Consequently, primary cranial surgery must not make impracticable the procedures of secondary craniofacial surgery. Consequently, the neuro-surgeon - acting as a cranial surgeon - must keep intact the "orbito-frontal bandeau" 25 mm high, orbital roof and the fronto-zygomatic sutures, included and also temporal crests and temporal muscles. When these elements have been dissected or removed, they must be replaced or reconstructed. Moreover, bone grafts assigned to the fixation or construction of the mid face are more and more often harvested from the parietal bones. Consequently, the parietal bones may be isolated by craniotomies; they must not be destroyed by craniectomies.