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and lateral margins bilaterally and to allow stripping of the periorbita from the walls. The supraorbital nerve and artery are easily preserved within the reflected tissue, although at times a small osteotomy is necessary to mobilize the neurovascular bundle from the osseous margin. The temporal fascia and muscle are stripped anterosuperiorly and along the anterior margin of attachment sufficiently to allow exposure of the lateral orbital rim and placement of a burr hole immediately behind the orbital process of the frontal bone below the superior temporal line

S kulls deformed by metopic, unilateral, or bilateral coronal synostosis result in diminished projection of the supralateral orbital rim. 1, 5–13 In addition, individuals with coronal and to a lesser extent metopic synostosis have reduced anteroposterior projection of the zygoma ( Fig. 1 ). Although many methods have been described to correct the orbital rim abnormalities, the lateral canthal advancement technique is presently the most widely practiced. 7 There are two problems with this technique, however. First, with this procedure, the advancement of the

age. The horizontal advancement techniques of Tessier, 22 later refined and altered by numerous authors, 1, 5, 6, 9, 14, 20 provided consistently better cosmetic results. In the midst of these operative refinements, however, problems persisted in the older pediatric population; these included lateral orbital wall step-off, malar hypoplasia, resorption of interposed osseous struts with collapse, inadequate fixation, and palpable fixation hardware. We have applied a means of advancing the orbital rim and zygoma in cases of unilateral coronal synostosis which is

M uch attention in the neurosurgical literature has been focused on the use of orbitozygomatic osteotomy to facilitate exposure along the base of the brain. Although the traditional techniques of frontal, temporal, and pterional craniotomy are adequate for reaching many lesions located in the regions of the interpeduncular fossa, clivus, and cavernous sinus, newer methods involving disarticulation of the orbital rim and zygomatic arch have increasingly been used. 6, 7, 11, 12, 16, 26 The goal of these surgical adjuncts has been to improve exposure areas and to

P remature unilateral coronal synostosis (plagiocephaly) is a congenital abnormality of the skull, with a characteristic clinical and radiological picture. Early surgical treatment has been advised for the prevention of exophthalmos, visual loss, 10 cosmetic deformities, and brain damage. 8 The clinical picture of coronal synostosis, usually present at birth, consists of flattening of the frontal region and asymmetrical orbits, with resultant facial asymmetry. A palpable ridge at the margins of the coronal suture and flattening of the supraorbital rim are

situation occurs, the most common current surgical treatment entails a bicoronal scalp incision and exposure of both frontal bones and supraorbital rims. A classic orbital bandeau and frontal bone advancement is done so that the eyelids may properly close, and the eyes are adequately protected. Not uncommonly, this leaves the patient with an abnormally shaped face and significantly overriding eyebrows. Later surgery is needed to perform a midface advancement. In some cases, relapse of the first orbital frontal advancement requires a second operation. Given our success

T o minimize brain retraction and to obtain a wide working space, various types of craniotomies including the superior orbital rim have been developed. 1, 4, 8, 10, 12, 18, 19 Recently, a mobilization of zygoma in addition to the craniotomy has been reported to offer an excellent exposure of the cranial base. 5–7, 9, 13, 14, 16, 17, 20, 21 In most of the techniques reported previously, 1, 5–7, 9, 10, 13, 14, 16–19, 21 a part of the basal bone structures of the orbital roof, the sphenoid ridge, and the temporal bone were inevitably resected. This removal led

canthotomy incision is made, extending from the lateral epicanthus 2 cm laterally as far down as the lateral orbital ridge ( Fig. 2A ). Next, the periosteum is dissected off of the lateral orbital rim until the orbitozygomatic and frontoorbital junctions are exposed. Then, the temporalis muscle and the periorbita on both sides of the lateral orbital wall are dissected ( Fig. 2B ). The dissection on these planes is continued intraorbitally to the lateral projection of the superior orbital fissure, and, extraorbitally, a 2-cm segment of temporal bone along with the

) and frontal-basal (33 cases). Frontal-basal fractures were associated with damage to the cribriform plate, frontal or ethmoidal sinuses, and orbital rim; frontal-vault fractures were those without associated cranial or sinus injuries. The frontal-basal group included 25 fractures of the cribriform plate, 13 of the orbital rim, and 19 involving frontal or frontal and ethmoid sinuses. Compound fractures predominated in our series of frontal fractures (80%). Table 1 correlates the incidence of dural and underlying brain injury with different fracture sites. Compound