Losken H W, Pollack I F, Singhal V K
Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.
J Craniofac Surg. 1996 Mar;7(2):107-10. doi: 10.1097/00001665-199603000-00005.
Fronto-orbital advancement is the procedure of choice for correction of fronto-orbital recession resulting from coronal synostosis in children. However, long-term follow-up evaluations often reveal "undercorrection" of the deformity with development of recurrent recession of lateral supraorbital regions. One factor that may contribute to this process is devascularization of the fronto-orbital bar during its reshaping and advancement. If subsequent revascularization is suboptimal, excessive resorption or inadequate growth of the bar may lead to supraorbital recession. On the basis of studies of temporal bone grafts, which have shown that vascularized grafts are superior to free bone grafts in terms of bone graft survival, we postulated that maintaining vascularization of the fronto-orbital bar would favor better healing and growth that would translate to more favorable aesthetic results. Herein, we review the vascular anatomy of the fronto-orbital region and report the application in six patients of a technique for fronto-orbital advancement that preserves a significant portion of this blood supply. Technical caveats involved in the successful application of this approach are discussed. The attachment of the periosteum to the lateral two thirds of the supraorbital bar allows additional stability. This prevented the use of plates and screws in these patients.
额眶前移术是矫正儿童冠状缝早闭所致额眶后缩的首选手术方法。然而，长期随访评估常常显示畸形存在“矫正不足”，眶上外侧区域反复出现后缩。这一过程的一个可能促成因素是额眶骨条在重塑和前移过程中血运受损。如果随后的血管再生不理想，骨条过度吸收或生长不足可能导致眶上后缩。基于对颞骨移植的研究，这些研究表明带血管蒂移植骨在骨移植存活方面优于游离骨移植，我们推测维持额眶骨条的血运有利于更好的愈合和生长，从而带来更理想的美学效果。在此，我们回顾额眶区域的血管解剖，并报告一种保留大部分血供的额眶前移技术在6例患者中的应用情况。讨论了成功应用该方法所涉及的技术注意事项。骨膜附着于眶上骨条的外侧三分之二可提供额外的稳定性。这使得这些患者无需使用钢板和螺钉。
