title: Timing of treatment for craniosynostosis and facio-craniosynostosis: a 20-year experience.
abstract: The timing of surgery for craniosynostosis is still controversial. Having used the same basic techniques since 1973, and having done follow-up on the growth of our 983 operated patients, we thought it useful to report our protocol. Early frontocranial remodelling is performed between 2 and 4 months for brachycephalies, but the other craniosynostoses are operated on between 6 and 12 months of age. When diagnosis is made later, we perform the same operations until 4 years of age, with some modifications, such as a tongue in groove advancement for brachycephalies, and a complete closure of the bony defects after 2 years of age. Later on, facial distortion and frontal sinus development complicate the surgery. For syndromal craniofacial synostosis, we prefer to perform a two-step operation: forehead advancement first, facial advancement later, to avoid the risk of frontal osteitis. The frontofacial monobloc is indicated, in our opinion, for severe exorbitism in infancy but otherwise we prefer a two-stage procedure. Facial bipartition is necessary to narrow the upper face and widen the maxilla in Apert's syndrome.
authors.affiliation: Craniofacial Unit, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Marchac
authors.forename: D
authors.initials: D
authors.lastname: Renier
authors.forename: S
authors.initials: S
authors.lastname: Broumand
mesh_terms: D000168:Acrocephalosyndactylia / Q000601:surgery; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003394:Craniofacial Dysostosis / Q000601:surgery*; D003398:Craniosynostoses / Q000150:complications / Q000601:surgery*; D005149:Facial Expression; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications; D007223:Infant; D008297:Male; D012886:Skull / Q000601:surgery*; D013518:Surgery, Plastic / Q000379:methods