Timing of treatment for craniosynostosis and faciocraniosynostosis: a 20-year experience

Daniel Marchac, Dominique Renier, Stafford Broumand

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151 Scopus citations

Abstract

The timing of surgery for craniosynostosis is still controversial. Having used the same basic techniques since 1973, and having done follow-up on the growth of our 983 operated patients, we thought it useful to report our protocol. Early frontocranial remodelling is performed between 2 and 4 months for brachycephalies, but the other craniosynostoses are operated on between 6 and 12 months of age. When diagnosis is made later, we perform the same operations until 4 years of age, with some modifications, such as a tongue in groove advancement for brachycephalies, and a complete closure of the bony defects after 2 years of age. Later on, facial distortion and frontal sinus development complicate the surgery. For syndromal craniofacial synostosis, we prefer to perform a two-step operation: forehead advancement first, facial advancement later, to avoid the risk of frontal osteitis. The frontofacial monobloc is indicated, in our opinion, for severe exorbitism in infancy but otherwise we prefer a two-stage procedure. Facial bipartition is necessary to narrow the upper face and widen the maxilla in Apert's syndrome.

Original languageEnglish
Pages (from-to)211-222
Number of pages12
JournalBritish Journal of Plastic Surgery
Volume47
Issue number4
DOIs
StatePublished - 1994
Externally publishedYes

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