Jeyaraj Priya
Armed Forces Medical College, Pune, 411040 India.
J Maxillofac Oral Surg. 2012 Sep;11(3):358-63. doi: 10.1007/s12663-011-0309-7. Epub 2011 Dec 23.
The gold standard for surgical correction of both uni- and bilateral coronal synostosis remains to this day, the "standardised bilateral fronoto-orbital advancement and reshaping" based on the "tongue in groove" technique developed by Tessier. It consists of bilateral frontal craniotomy for suture release and decompression, combined with creation of a "supraorbital bar" as a bilateral orbital complex by osteotomising the orbital roof (anterior cranial base), supraorbital ridge and upper lateral orbital rims bilaterally. This is followed by a bilateral advancement and remodelling of the frontal region as well as the orbital region bilaterally which is then rigidly fixed in position, the supraorbital bar to the face (at the fronto-zygomatic region and the fronto-nasal region) and the reconstructed forehead to the supraorbital bar. In this study, a slightly modified procedure was employed for correction of the right sided unilateral coronal synostosis, using a bifrontal craniotomy combined with unilateral orbital osteotomy (creating a unilateral supraorbital bar/bandeau), followed by radial osteotomies/kerfing, reshaping and advancement of the bifrontal calvarial segment. This was followed by the "tongue in groove" advancement of the right orbital segment (unilaterally). We preferred to spare osteotomising the contralateral (that is, the left) orbital region as it was not involved by compensatory growth deformity, and the frontal bossing/bulging was restricted to the upper forehead region alone. A gratifying aesthetic outcome and perfect symmetry was achieved using this technique. There were also no complications like wound infection or dehiscence, CSF leak, bone loss from resorption, damage to orbital contents or brain, recurrence of the dysmorphology or residual deformities or asymmetrics of the orbital region or forehead. Gratifying cosmetic results were seen using this modified technique and it was found that bilateral frontal reshaping and unilateral orbital advancement together with kerfing the frontal segment followed by fixation using resorbable implants is an effective strategy to not only permit remodelling of the skull and face thus correcting the cosmetic deformity, but also to increase the intracranial volume within the anterior cranial vault, without the need for any graft placement.
单冠状缝和双冠状缝早闭手术矫正的金标准至今仍是基于泰西埃开发的“榫槽”技术的“标准化双侧额眶前移和重塑”。它包括双侧额骨切开术以松解缝合线和减压，同时通过双侧截骨眶顶（前颅底）、眶上嵴和眶上外侧缘来创建一个“眶上杆”作为双侧眼眶复合体。随后是双侧额部区域以及双侧眼眶区域的推进和重塑，然后将其牢固地固定到位，眶上杆固定到面部（额颧区域和额鼻区域），重建的额头固定到眶上杆。在本研究中，采用了一种略有改良的手术方法来矫正右侧单侧冠状缝早闭，即采用双额骨切开术联合单侧眼眶截骨术（创建单侧眶上杆/头带），随后进行放射状截骨/刻痕、双额颅骨段的重塑和推进。接着是右侧眼眶段的“榫槽”推进（单侧）。我们倾向于不截骨对侧（即左侧）眼眶区域，因为它未受代偿性生长畸形影响，且额部隆起/凸出仅局限于前额上部区域。使用该技术获得了令人满意的美学效果和完美对称。也没有出现诸如伤口感染或裂开、脑脊液漏、吸收导致的骨质流失、眼眶内容物或脑损伤、畸形复发或残留畸形或眼眶区域或额头不对称等并发症。使用这种改良技术可看到令人满意的美容效果，并且发现双侧额部重塑和单侧眼眶推进，再加上额段刻痕，然后使用可吸收植入物固定，不仅是一种有效的策略，可使颅骨和面部重塑从而矫正美容畸形，还能增加前颅窝内的颅内体积，而无需任何植骨。
