Surgical procedures
Correcting forehead shape and orbital rim in craniosynostosis – eye protection, timing, technique and outcomes.
Fronto-orbital advancement (FOA) is a combined neurosurgical–craniofacial procedure in which the frontal bone and the bony orbital rim are moved forward together. It pursues two goals at once: normalising the skull contour and — importantly — protecting the cornea from drying and injury in protruding eyes (exophthalmos).
It is performed in close collaboration between neurosurgery and craniofacial surgery.
With marked exophthalmos and corneal risk, FOA may be brought forward for ophthalmological reasons.
Typically between the 6th and 12th month of life. The brain grows very quickly at this age — the procedure uses this growth as a supporting force. In syndromic forms or acutely raised intracranial pressure, earlier intervention may be necessary.
Through a bicoronal incision (behind the hairline) the frontal bone is exposed. Frontal bone and orbital rim are mobilised as one segment, moved into the new position and fixed with resorbable plates and screws. The reshaped bone integrates fully within a few months. Duration: approx. 3–5 hours. A postoperative intensive-care stay of 24–48 hours is routine.
FOA has very good long-term results for contour and function. The cornea is permanently protected by orbital advancement. Revision surgery is possible but not the rule. In syndromic forms, further procedures follow in the treatment plan (PVDO, Le Fort III).
Overview: surgical procedures · Craniosynostosis · Crouzon · Apert · Pfeiffer
It is an operation in which the forehead and upper eye-socket rims are reshaped and moved forward to give the brain room and correct the head shape. The exact procedure is planned individually.
The timing depends on diagnosis and findings and is set by the specialist centre. It is often performed in infancy or early childhood.