Fronto Orbital Advancement

Fronto Orbital Advancement

The most common surgery used to treat craniosynostosis is called fronto-orbital advancement with cranial vault remodeling. This major craniofacial operation expands the space of the skull while improving facial appearance, particularly around the eyes.

What is Craniosynostosis?

The skulls of children affected by craniosynostosis grow abnormally and are often misshapen. The problem lies in the cranial sutures of the bones of the skull. In normal children, these sutures remain open, giving the rapidly growing brain space to expand along with the skull, but in children with craniosynostosis, these joints close early. The brain does not have room to grow, which can result in brain compression and potential problems with brain function if left untreated. Therefore, surgery to expand the skull is recommended.

The virtual patient in the fronto orbital advancement CIVA demonstration has bicoronal craniosynostosis. Because the brow bone is pushed back, the eyes bulge, but the remainder of the forehead protrudes over the brow bone. The skull appears wide when looking at the infant straight on and narrow when looking towards its side. There are other forms of craniosynostosis, as well. Depending on the patient’s type of craniosynostosis, the skull and face may have a different shape.

Hear Peter’s FOA story from his parents:

How does a Fronto Orbital Advancement help?

After surgery, the brain has room to grow and once the swelling subsides, the facial appearance is improved. Although effective, cranial vault remodeling is a major operation which takes many hours to perform. A blood transfusion may be required and there can be a lot of facial swelling. A craniofacial surgeon and a pediatric neurosurgeon work together; they separate the forehead and a band of bone just above the eyes from the remaining skull.

Visit CIVA, The Craniofacial Interactive Virtual Assistant, to experience a virtual presentation of a Fronto Orbital Advancement.

Watch Nurse Practitioner, Pat Chibbaro, of the myFace Center for Craniofacial Care at NYU Langone Health explain a Frontal Orbital Advancement surgery:

The Process of a Fronto-Orbital Advancement Procedure

Pre-Surgery

Because a blood transfusion may be used during the operation, some families choose to donate blood for the operation before the surgery.

Procedure

Once the patient is asleep, many monitoring devices will be placed to ensure safety throughout the operation. An opening is made on the top of the scalp from one side of the ear to the other. In most cases, the entire operation can be performed using only a scalp incision called a coronal incision. This opening may take the form of a wavy line to help hide the scar within the hair.

During the procedure, the forehead bone will be separated from the skull first. Then a band of bone is removed from the brow area. This includes the top of the eye sockets and parts of the temple. Once the forehead and brow section are removed, the bones are molded by the craniofacial surgeon into a shape that gives a more natural contour to the face. After the bones have been reshaped, they are returned to the skull in a forward position to create more space for the brain and improve facial appearance. The bones are then secured into place with dissolvable plates, screws and sutures. Occasionally metal may be used to keep the bones secured, but this will be decided by the surgeon. Once the bones have been secured, the scalp is closed. A small drainage tube may be placed under the scalp skin. This drain exits by the ear into a collection bulb, which the patient will be able to see during recovery.

Post-Op & Recovery

After the surgery you will see a bandage around the head. Fluid may drain from the scalp incision. Most of this fluid will stop draining after a couple of days. The patient’s brow and forehead shape – and position – will have noticeably improved. These bones are commonly placed in a forward position that makes brow and forehead appear “strong” or slightly overcorrected. This is a normal part of the reconstructive plan to account for growth.

Swelling & Discomfort

It is important to note, this surgery does produce dramatic swelling around the eyes. It is usually not bad at first, but increases rapidly over two days. Commonly, the eyes swell shut over the course of those two days and then slowly resolve over several days. Most of the discomfort experienced after the surgery will be from the swelling of the face rather than the pain from the surgery itself and medicine will be given to help with any discomfort. Cool compresses to the face and sleeping with the face raised above the heart will also help decrease the swelling. Bruising around the eyes can also develop, but this will resolve over the course of approximately 2 weeks.

Visit CIVA, The Craniofacial Interactive Virtual Assistant, to experience a virtual presentation of a Fronto Orbital Advancement.

Meet Alonso, a member of the myFace community who had a Fronto Orbital Advancement

Image of Dr. David Staffenberg with a young patient holding a stethoscope to Dr. Staffenberg's heart.Alonso is the youngest of a loving, close knit family of 5 who came to the US from the Dominican Republic in 2015 when he was just a baby. Born with Crouzon Syndrome, he was later diagnosed with Craniosynostosis – two craniofacial conditions that resulted in the bones of his face and skull not forming properly.

Read Alonso’s story →

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