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Demystifying Exposure: Periosteal Releases Of The Frontal Orbital Advancement
Katherine Grunzweig MD, Corinne Wee MD, Edward Davidson MD, Anand Kumar MD
University Hospitals Cleveland Medical Center
2020-02-15
Presenter: Katherine Grunzweig
Affidavit:
Katherine Grunzweig has been responsible for the majority of conception, research, writing and preparation of this abstract. It has not been submitted at any other meeting or journal.
Director Name: Anand Kumar
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Exposure of the fronto-orbital bar during advancement is often limited by three key sutures: the zygomatico-frontal, zygomatico-sphenoid, and fronto-nasal suture lines. The overlying densely adherent periosteum can be scored for exposure during osteotomy, and expansion of the soft tissue minimizes tension/relapse on the advanced bandeau segment. Our study sought to explore the key maneuvers for periosteal release.
Methods: This technique paper is based on the cumulative experience of our senior craniofacial surgeon, with contribution of our other craniofacial faculty. Images of surgical markings and direct measurement before and after release were obtained.
Results: When nearing the frontal-orbital bar, anterior exposure and draping of the soft tissue can be constricted around the tight bandeau. Exposure can be obtained with periosteal releases using Colorado tip electrocautery at the zygomatic frontal, zygomatic sphenoid, and frontal nasal suture lines. Exposure at the ZF and FNS were improved by 22%. Further techniques include exposure of the temporal fossa to reach the pterion, elevating temporalis as part of the skin flap to allow ease of re-tensioning temporalis at closure, and not mistakenly incising the intrinsic auricular muscle. Additionally, this access to release the ZF suture.
Conclusions: Calvarial remodeling and frontal orbital advancement for the treatment of craniosynostosis are well described. The specific approach for exposure of the frontal orbital bar is not well described to our knowledge, and what seems a simple maneuver of periosteal release can result in the difference between standard and optimal exposure of the frontal bar.
Key words: calvarial vault, craniofacial, fronto-orbital bandeau
