Frontoorbital Advancement and Forehead Remodeling for Correction of Anterior Calvarial Craniosynostosis, Surgical Technique and Results in Low Economic Facilities: Benha Experience

Abstract
Background: Craniosynostosis is a congenital problem that affects brain development and causes disfigurement of the head and face. Anterior calvarial craniosynostosis involves the metopic and/or coronal sutures. The most accepted surgical correction involves frontoorbital advancement and forehead remodeling. Lack of knowledge about craniosynostosis, the need for equipped facilities in addition to the fear of compli-cations from surgery led to delay in doing surgery at the optimum age, and with this delay more complex surgical techniques are needed, with a less favorable outcome.
Aim of the Study: In this study, we described our experience and technique in surgical correction of anterior calvarial craniosynostosis at Benha University Hospital using the frontoorbital advancement technique without the use of any expensive miniplates or helmets compensating the low soci-oeconomic standard of the community.
Study Design: This is a retrospective study case series of 15 patients, their ages ranged from 4 to 30 months. All patients have anterior calvarial craniosynostosis and were treated surgically using the frontoorbital advancement technique. Patients had been followed after surgery for a period of time ranged from 8 to 20 months during the years from March 2013 to December 2016.
Patients and Methods: Fifteen patients were included; four with pure metopic craniosynostosis, five with combined metopic and coronal, four patients with bilateral coronal and two with unilateral coronal. Patients were clinically and radiologically evaluated using CT scan skull with 3D recon-struction. Pre and post-operative scans as well as patient photographs have been compared and evaluated for the degree of correction of the relationship between the supra orbital bar and the cornea as well as the degree of correction of the deformity in the face and forehead.
Results: Out of 15 patients with craniosynostosis involved in this study, 11 (73.3%) patients had achieved very good cosmetic and functional outcome, two patients (13.3%) had an unsatisfactory cosmetic outcome in the form of irregularities in the shape of the skull that necessitated to do another surgery, one patient (6.67%) had a bad cosmetic outcome, and one patient died in the early post-operative period.
Conclusion: Frontoorbital advancement with forehead remodeling is the best option for treating anterior calvarial craniosynostosis. For achieving better results surgery should be done at the optimum age and in well equipped medical center. Although using miniplates and helmets may help with the outcome, surgery can be performed with minimal resources in accordance with the economic state of the community with good results.