Vascularized Fronto-Orbital Advancement

Losken, H. Wolfgang; Pollack, Ian F.; Singhal, Vinod

doi:10.1097/00001665-199603000-00005

Cited by 14 publications

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We also cannot rule out the possible role of surgical disruption of growth, either due to disruption of a "functional matrix," 19 atrophy of the temporalis muscles, 20 or devascularization of the supraorbital bar. 21 Alternatively, operating at a later age is less influenced by future growth and bone is stronger, although perhaps less elastic.…”

Section: Timing Of Surgerymentioning

confidence: 99%

Machine Learning in Metopic Craniosynostosis: Does Phenotypic Severity Predict Long-Term Esthetic Outcome?

Blum

Beiriger

Villavisanis

et al. 2022

Journal of Craniofacial Surgery

View full text Add to dashboard Cite

Background: There have been few longitudinal studies assessing the effect of preoperative phenotypic severity on long-term esthetic outcomes in metopic craniosynostosis. This study evaluates the relationship between metopic severity and long-term esthetic outcomes using interfrontal angle (IFA) and CranioRate, a novel metopic synostosis severity measure. Methods: Patients with metopic craniosynostosis who underwent bifrontal orbital advancement and remodeling between 2012 and 2017 were reviewed. Preoperative computed tomography head scans were analyzed for IFA and CranioRate, a machine learning algorithm which generates quantitative severity ratings including metopic severity score (MSS) and cranial morphology deviation (CMD). Long-term esthetic outcomes were assessed by craniofacial surgeons using blinded 3-rater esthetic grading of clinical photos. Raters assessed Whitaker score and the presence of temporal hollowing, lateral orbital retrusion, frontal bone irregularities and/or “any visible irregularities.” Results: Preoperative scans were performed at a mean age of 7.7±3.4 months, with average MSS of 6/10, CMD of 200/300, and IFA of 116.8±13.8 degrees. Patients underwent bifrontal orbital advancement and remodeling at mean 9.9±3.1 months. The average time from operation to esthetic assessment was 5.4±1.0 years. Pearson correlation revealed a significant negative correlation between MSS and age at computed tomography (r=−0.451, P=0.004) and IFA (r=−0.371, P=0.034) and between IFA and age at surgery (r=−0.383, P=0.018). In multinomial logistic regression, preoperative MSS was the only independent predictor of visible irregularities (odds ratio=2.18, B=0.780, P=0.024) and preoperative IFA alone significantly predicted Whitaker score, with more acute IFA predicting worse Whitaker score (odds ratio=0.928, B=−0.074, P=0.928). Conclusions: More severe preoperative phenotypes of metopic craniosynostosis were associated with worse esthetic dysmorphology. Objective measures of preoperative metopic severity predicted long-term esthetic outcomes.

show abstract

Section: Timing Of Surgerymentioning

confidence: 99%

Machine Learning in Metopic Craniosynostosis: Does Phenotypic Severity Predict Long-Term Esthetic Outcome?

Blum

Beiriger

Villavisanis

et al. 2022

Journal of Craniofacial Surgery

View full text Add to dashboard Cite

show abstract

“…[6][7][8] There are many reports describing the improvement of fronto-orbital advancement by distraction osteogenesis. [8][9][10] In cases with unfavorable results, the secondary surgical procedure is performed to improve the shape and appearance of the fronto-orbital area and decrease intracranial pressure. The secondary operation is more difficult and riskier than the primary operation because of the risk of infection, the loss of much blood from the scar, the existence of bone defects, the possibility of tearing the dura, and other reasons.…”

mentioning

confidence: 99%

Additional Distraction Osteogenesis After Conventional Fronto-Orbital Advancement

Fujimori

Ueda

Oba

2005

Journal of Craniofacial Surgery

View full text Add to dashboard Cite

In the conventional fronto-orbital advancement method, there is a limit to advancement because of scalp skin tension and an absence of a supraorbital bar fixating point. In a case of insufficient advancement after the primary operation, a secondary re-advancement must be performed. In such a condition, additional fronto-orbital advancement by distraction osteogenesis has proved to be very useful. The authors used additional distraction osteogenesis in three infant cases: two of nonsyndromic craniosynostosis and one of Apert's syndrome. They were able to perform these operations safely using their original internal devices. Distraction was started 3 days after the operation. The rate of advancement was 0.5 to 1.0 mm per day. The distraction distances ranged from 16 to 22 mm. They were able to gain enough advancement in all three cases. A reoperation of a fronto-orbital advancement is more difficult than the primary operation because of possible infection, much loss of blood, low blood supply to advanced bones, a tendency of advanced bones to relapse, increased scalp skin tension, and the existence of bone defects. In these poor conditions, distraction osteogenesis has many advantages: good vascularization, no relapsing, a low infection rate, and no need for bony fixating points in the bone defects. Although it is necessary to have a secondary operation to remove the devices and prolonged hospitalization is required, the disadvantages are far outweighed by the many advantages when performing additional fronto-orbital advancement.

show abstract

The shell technique: bilateral fronto-orbital reshaping in trigonocephaly

2012

View full text Add to dashboard Cite

The shell technique, used in the Pediatric Neurosurgical Department at the Catholic University, Rome, since the 1990s for the correction of trigonocephaly, is associated to a significant reduction in surgical time and intraoperative blood loss as compared to other procedures, while allowing an adequate remodelling of the bifrontal bone by means of multiple radial osteotomies. The technique does not necessitate the creation of a supraorbital bar, as the supraorbital ridges are modified in situ, further reducing the operative blood loss. In spite of reduced surgical time and manipulation, this procedure ensures aesthetic and functional results comparable to more extensive and complex cranial vault reshaping procedures. The main limitation of this technique is related to the surgical timing, as better results are obtained between 3 and 9 months of age, when the skull bone is still ductile to work with, thus allowing it to be remodelled by greenstick fractures. Moreover, in this age group, the cranial defects that result from the enlargement of the frontal bone flap by means of radial cuts and from the anterior displacement of its lateral portions may benefit from the more effective bone regeneration which characterizes younger children as compared to their older counterparts. A small number of cases showing either persistent hypotelorism or temporal depression have been observed in the post-operative period, although these residual deformities probably depend on a more extensive involvement of the cranial base in the synostotic process in these patients than on the procedure itself.

show abstract

Vascularized Fronto-Orbital Advancement

Cited by 14 publications

References 0 publications

Machine Learning in Metopic Craniosynostosis: Does Phenotypic Severity Predict Long-Term Esthetic Outcome?

Machine Learning in Metopic Craniosynostosis: Does Phenotypic Severity Predict Long-Term Esthetic Outcome?

Additional Distraction Osteogenesis After Conventional Fronto-Orbital Advancement

The shell technique: bilateral fronto-orbital reshaping in trigonocephaly

Contact Info

Product

Resources

About