Surgical procedures
Fronto-orbital advancement, Le Fort III, monobloc, posterior vault distraction and spring-assisted cranioplasty – overview with indications and timing.
The surgical treatment of craniosynostosis depends on the suture involved, the severity of the deformity, functional problems and the age of the child. There is no universal protocol: the choice of procedure and timing is individual and requires an experienced, interdisciplinary craniofacial team.
Broadly, we distinguish procedures on the anterior cranial vault, the posterior cranial vault and the midface — used alone or in combination, and at different ages.
| Procedure | Typical age | Main indication |
|---|---|---|
| Spring-assisted cranioplasty | 3–6 months | Sagittal suture synostosis (scaphocephaly) |
| Fronto-orbital advancement (FOA) | 6–12 months | Coronal/metopic synostosis; syndromic |
| Posterior vault distraction (PVDO) | 1st–2nd year | Raised ICP, Pfeiffer type 2/3, turricephaly |
| Le Fort III distraction | 6–12 years | Syndromic midface hypoplasia |
| Monobloc distraction | 4–14 years | Severe combined forehead & midface deformity |
| Orthognathic surgery | from 16–18 years | Residual malocclusion after growth |
In non-syndromic single-suture synostoses (sagittal, unilateral coronal, metopic) a single procedure in infancy is usually sufficient — either endoscopic minimally invasive with subsequent helmet therapy, or an open reconstruction.
In syndromic craniosynostoses (Crouzon, Apert, Pfeiffer, Saethre-Chotzen, Muenke and others) treatment is staged and often extends throughout childhood and adolescence. A typical staged plan:
Craniofacial procedures require close collaboration between craniofacial/maxillofacial surgery, neurosurgery, anaesthesiology, ophthalmology, ENT and orthodontics. All procedures are planned and performed at specialised centres.
Depending on the suture involved and the age, options range from endoscopic strip craniectomy and spring-assisted techniques to open cranial remodelling and midface distraction. The suitable method is chosen individually at a specialist centre.
The timing depends on the form and findings and is planned individually. Interdisciplinary assessment at a specialist centre is recommended.