Abstract
The techniques of frontofacial surgery are most valuable in the clinical management
of complex craniofacial deformity to achieve a range of functional and aesthetic gains
in children from infancy to maturity. A variety of complex craniofacial osteotomies
that can be used to separate the orbits from the skull base have been described. In
addition, the combination of circumorbital release and pterygomaxillary disjunction
allows advancement of the orbitomaxillary segment for powerful clinical benefit. For
the purpose of this article, the principal frontofacial strategies include the monobloc
frontofacial advancement by distraction (MBD), frontofacial bipartition advancement
by distraction (BpD), orbital box osteotomy (FFBx), and frontofacial bipartition (FFBp).
These techniques are broadly used for two purposes: to allow for the translocation
of one or both orbits to correct orbitofacial disproportion (hypertelorism, vertical
orbital dystopia, or a combination of both), or to advance the orbitomaxillary segment
for orbital volume expansion and protection of the eye in syndromes featuring severe
exorbitism (oculo-orbital disproportion).
Here we describe aspects of our experience of frontofacial surgery in the Craniofacial
Centre at Great Ormond Street Hospital for Children, London, with reference to the
principles underpinning frontofacial surgical techniques, their challenges, and their
impact on function and aesthetics.
Keywords
Apert syndrome - Crouzon syndrome - Pfeiffer syndrome - hypertelorism - orbital dystopia
- monobloc
