Reconstruccion frontoorbital

Atlas Oral Maxillofacial Surg Clin N Am 10 (2002) 43–56

Frontoorbital reconstruction
Steven R. Buchman, MDa,b,c,*, Karin Muraszko, MDd,e
Section of Plastic and Reconstructive Surgery, University of Michigan Medical School, 2130 Taubryn Health Care Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0340, USA b Craniofacial Anomalies Program, University of Michigan Medical Center,1500 East Medical Center Drive, F7859 Mott Hospital, Ann Arbor, MI 48109-0219, USA c Division of Pediatric Plastic Surgery, CS Mott Children’s Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA d Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA e Division of Pediatric Neurosurgery, CS Mott Children’s Hospital, Ann Arbor, MI 48109, USA
aFrontoorbital reconstruction is one of the mainstays of surgical management for craniofacial deformities. Variations on operative procedures using frontoorbital advancement (FOA) as a basis to achieve surgical correction of congenital deformities of the face and skull provide the foundation for addressing a large number of reconstructive needs in craniofacial surgery. Specifically, FOA proceduresentail removal of the bones of the forehead, supraorbital rims, and calvarium, reshaping and repositioning those bones, and stable fixation of the reconstruction (Fig. 1B; see Figs. 4B, 6B). This article outlines the current management of craniofacial deformities using FOA as a treatment strategy. The article addresses patient selection, surgical indications and timing of treatment, perioperativecare, and operative techniques. This article is in no way meant to be a primer for the undertaking of this complex multifaceted procedure but rather is a source of information to better understand the approach to the reconstructive the approach to the reconstructive dilemmas posed by a unique group of patients with challenging congenital deformities. Only trained craniofacial surgeons, in appropriatefacilities, with dedicated assembled teams should take on the care and responsibility for these high-risk procedures. The specialized care and expertise required by the patients in need of FOA is not to be underestimated. Serious complications such as brain damage, blindness, and death are known risks of the FOA procedure and can become more likely when the surgical management of these patientsis approached in a cavalier manner. To address various congenital deformities, craniofacial surgeons use the FOA procedure with success. Patients with syndromic and nonsydromic craniosynostosis make up the overwhelming majority of cases that require the procedure. As in most surgical procedures, patient selection is one key to obtaining an excellent outcome. The most common groups of patients whorequire FOA are those with plagiocephaly secondary to unicoronal craniosynostosis (Figs. 1A, 2, 3), brachycephaly secondary to bilateral coronal craniosynostosis (Figs. 4A, 5), and trigonocephaly secondary to metopic craniosynostosis (Figs. 6A, 7). A sound insight into the variables that influence these craniofacial malformations may well be a key predictor of growth abnormalities, which could beinvaluable in the development and application of surgical strategies tailored to each individual patient and to each individual diagnosis. Although many of these patients display a wide spectrum of phenotypes, the basic principles underlying the scope, timing, and approach to these complex craniofacial anomalies are based on the solid fundamental principles and tenets of craniofacial reconstruction.Patients with disparate craniosynostoses often undergo a similar pattern of reconstructive procedures to achieve improvements in the shape, symmetry, and balance of their face and cranial vault. The overall reconstructive goals of maximizing

* Corresponding author. E-mail address: sbuchman@umich.edu (S.R. Buchman). 1061-3315/02/$ - see front matter Ó 2002, Elsevier Science (USA). All rights...