WP Chung O T in Craniofacial Surgery 9781496348265

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Chapter 1 Fronto-Orbital Advancement

Approach

■ This procedure also addresses the issues of reducing the like- lihood of postoperative depressions in the anterior temporal fossa and adds forward, stable projection of the supraor- bital rim, without the added potential for restricting post- operative growth due to rigid fixation.

■■ Fronto-orbital advancement via the tilt procedure is the authors’ preferred approach. 16–19 ■■ It has the main advantage of potentially greater preservation of baseline blood supply to the osteotomy segments.

T E C H N I Q U E S

■ Incisions for the Tilt Procedure

■ All incisions should include injection of local anes- thetic with epinephrine and intraoperative use of clot- ting agents (such as aminocaproic acid and tranexamic acid). ■ Exposure of the frontal and periorbital regions bilaterally is appropriate for both coronal synostosis and metopic synostosis to assess symmetry ( TECH FIG 1D ). ■ Intraoperative confirmation of fused sutures is made. ■ Subperiosteal dissection is performed at the level of the orbital rims to expose the deficient projection of the rims ( TECH FIG 1E ). ■ General and specific operative steps and modifica- tions are given below based on the individual sutural pathology.

■■ Incision line is posteriorly inclined from the region just anterior to the ear, to the occiput below the level of the hair whorl to minimize scar visibility and ease of the visualization of the skull 20 ( TECH FIG 1A,B ). ■■ For the posteriorly inclined coronal incision, care must be taken to preserve the ascending branch of the superfi- cial temporal artery to maintain appropriate vascularity for the scalp ( TECH FIG 1C ). ■■ An alternative to this incision is to do either a straight coronal incision that is slightly posteriorly inclined or a stealth incision. ■■ These alternatives, however, have more potential vis- ible scarring and take longer to both incise and close.

Parietal branch of the superficial temporal artery and vein

A

Frontal branch of superficial temporal artery and vein

Superficial temporal artery and vein

Occipital artery and vein

Posterior auricular artery and vein Copyright © 2019 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

B

TECH FIG 1  • A,B. Preferred incision line is placed posteriorly toward the occiput below hair whorl to maximize skull exposure and minimize scar visibility postoperatively.

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