Pediatric Fronto-Orbital Skull Reconstruction

Abstract

Craniofacial surgery in children is a highly challenging discipline that requires extensive knowledge of craniofacial anatomy and pathology. Insults to the fronto-orbital skeleton have the potential to inflict significant morbidity and even mortality in patients due to its proximity to the central nervous system. In addition, significant aesthetic and ophthalmologic disturbances frequently accompany these insults. Craniosynostosis, facial trauma, and craniofacial tumors are all pathologies that frequently affect the fronto-orbital region of the craniofacial skeleton in children. While the mechanisms of these pathologies vary greatly, the underlying principles of reconstruction remain the same. Despite the limited data in certain areas of fronto-orbital reconstruction in children, significant innovations have greatly improved its safety and efficacy. It is imperative that further investigations of fronto-orbital reconstruction are undertaken so that craniofacial surgeons may provide optimal care for these patients.

Craniofacial Distraction Osteogenesis

“…15,45 FOA addresses these issues by correcting forehead contour and advancing the fronto-orbital complex around the age of 10 to 15 months. 25 The traditional procedure involves a frontal craniotomy consisting of a lower forehead and supraorbital bar that are osteotomized from the craniofacial skeleton and remodeled intraoperatively. 45 The forehead and supraorbital bars are plated together and reaffixed to the desired position on the frontal bone.…”

“…45 Additionally, FOD results in more stable postoperative results, with a cited relapse rate of 7 ( Table 1 ). 25 37 38 45 49 As the bone–dura interface is not disrupted in FOD, contour correction of the lower forehead bar is not extensive and therefore has limited ability to recreate the natural projection or widening of the forehead. 14 45…”

Orbital and Eyelid Characteristics, Strabismus, and Intracranial Pressure Control in Apert Children Treated by Endoscopic Strip Craniectomy versus Fronto-Orbital Advancement

“…Fused sutures are opened under endoscopic guidance at about 3–4 months of age, and orthosis is promoted by helmeting until age 1 year. 5 , 8 …”

“…7 Fronto-orbital advancement (FOA), the traditional open vault intervention for craniosynostosis, is commonly performed close to 1 year of age. 8 Endoscopic strip craniectomy (ESC) is a less-invasive alternative recently reintroduced as a possible alternative for this population. Fused sutures are opened under endoscopic guidance at about 3-4 months of age, and orthosis is promoted by helmeting until age 1 year.…”

“…Fused sutures are opened under endoscopic guidance at about 3-4 months of age, and orthosis is promoted by helmeting until age 1 year. 5,8 Many retrospective studies have demonstrated lesssevere V-pattern strabismus in patients with unicoronal synostosis treated by early ESC rather than by later FOA. [9][10][11][12][13] The apparent success in reducing ophthalmic morbidity in this population led to offering this alternative to appropriate patients with multisuture synostosis syndromes.…”