WP Chung O T in Craniofacial Surgery 9781496348265

T E C H N I Q U E S 6 Operative Techniques in Plastic Surgery: Craniofacial

TECH FIG 1 (Continued)  • C. Elevation of scalp flap in subgaleal plane with preservation of superficial temporal vessels. D. Subperiosteal dissection 1 cm above the orbital rim border to preserve neurovascular bundle of supraor- bital and supratrochlear vessels. E. Temporalis reflected to the level of pterion ( arrow ).

■■ Unilateral Coronal Synostosis Exposure and Bur Hole Placement

■■ Care is taken to avoid extensive dissection around the frontozygomatic suture to prevent disruption of the frontozygomatic suture soft tissue with advancement of the orbital rim. ■■ Advancement of the orbital rim is performed in situ with as minimal as possible disruption of the metopic-fronto- nasal suture tissue junction medially and the frontozygo- matic suture laterally ( TECH FIG 3E ): ■■ Angulation forward can be up to 1 to 1.5 cm (usually 1–1.2 cm), depending on the degree of deformity.

■■ Exposure of the frontal/parietal bones in the supraperi- osteal plane (less blood loss) ■■ Bifrontal craniotomy is performed with exposure of bilateral supraorbital rims, in a subperiosteal plane. ■■ Ipsilateral to the fused suture, the periorbita and anterior temporalis muscle (approximately the superior 50% of the origin of the muscle) is dissected from the underlying bone. ■■ Bur hole placement for the bifrontal craniotomy is placed more cephalad and posteriorly, so as to reduce the likelihood of depression in the frontal bone profile postoperatively. ■■ Bur hole placed on the fused side, as the coronal suture is displaced anteriorly. ■■ Measurement is made of the distance from the nor- mal coronal suture, contralateral to the fused suture, to the midline. This distance is transferred to the side ipsilateral to the fused suture to define the position of the osteotomy line, to get a symmetrical bifrontal bone segment for remodeling the frontal region ( TECH FIG 2 ). Supraorbital Rim Osteotomy and Advancement ■■ An orbital roof osteotomy is performed in situ, with a side-cutting bur and osteotomes from the lateral orbit to the anterior cribriform plate region ( TECH FIG 3A–D ).

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TECH FIG 2  • Location of bur holes relative to fused suture (tem- poralis muscle). Placement of bur hole posterior to coronal suture ( arrow ) is to prevent worsened temporal hollowness.

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