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Surgical Techniques for Fronto-Orbital Remodeling: A Systematic Review
Alexey Markelov, Renata Maricevich, Lilliana Camison, Wei Wei Lee, Jesse Goldstein
University of Pittsburgh Medical Center
2015-03-06
Presenter: Alexey Markelov
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction:
Fronto-orbital advancement (FOA) is the gold standard for surgical correction of both metopic and coronal synostosis. However, incredible variability exists in the description of surgical techniques for performing FOA. These variations and modifications in techniques might significantly impact short and long-term patient outcomes. The authors performed a systematic review of medical literature in order to analyze the degree and significance of these differences in surgical techniques.
Results:
Fifty papers from PubMed/MEDLINE database (1966-2014) were included in the analysis. 75% of articles represented case reports and case series with lower levels of evidence (level IV and V on ASPS evidence scale). 37% of papers described new techniques for FOA, while 13% described modifications to current surgical techniques. Only 17% of papers had control groups. Out of 1142 patients treated with various modifications of FOA, 68% had only short-term follow up. While 48% of papers described fixation with absorbable plates, 52% used other fixation modalities. Estimated blood loss (mean=218, SD=139) and operation duration (mean=240, SD=83) were also highly variable. Bandeau bone graft was used in 50% of cases, while 67% of papers reported using various techniques for frontal bone flap reshaping.
Conclusion:
There is no single widely used and accepted surgical approach for performing fronto-orbital advancement. Numerous variations in surgical technique obscure objective assessment of clinical results and make it difficult to perform prospective multicenter outcome based studies. The high prevalence of case reports and case series emphasizes the lack of scientific evidence in guiding selection of optimal technique for FOA.
