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Fronto-facial advancement for Crouzon's and Apert's syndromes.

This paper reviews the evolution of the surgical approach to the facial deformities in Crouzon's and Apert's syndromes. Since the first high maxillary osteotomy performed via an extracranial approach, various procedures have been used. These procedures were, successively, the intracranial route permitting simultaneous advancement of the mid-face and frontal bone in adult; then the use of trephine holes to protect the dura and brain during osteotomies obviating the need for a craniotomy. Likewise, more precise craniofacial fixation by interosseous wiring and bone grafting frequently obviate the need for intermaxillary fixation. More recently the fronto-facial advancement in one piece has been used in children between 4 and 10 years of age. The advantages and disadvantages of this procedure are considered.