Frontal Orbital Advancement

Patients born with asymmetrical deformities, particularly around the orbital region, require early surgical correction, which involves operating on the cranium, orbit, and upper facial area. The procedure also involves surgery on the skeleton in order to correct the asymmetry and produce symmetrization of the facial structures. The components of the face are osteotomized utilizing a plating system which involves screws and plates so that the components remain in position. Floating of those components on a stable structure allows the central nervous system to grow in order to achieve the natural structural and developmental integrity of the compressed segments of the brain. The final outcome is usually symmetrization of the face and normal developmental status of the patient.

In cases where the forehead is involved in
1. trigonocephaly
2. plagiocephaly, a technique called fronto-supraorbital advancement is used to correct the shape of the head. The procedure is performed at a young age in order to provide the brain with enough space to grow and prevent further abnormal growth of the skull. Fronto-orbital advancement literally means moving the front of the skull including the eye sockets forward. A section of the skull, ranging from the coronal sutures to the eye sockets is cut loose in order to correct the shape of the skull. The incision is cut in a zigzag shape from ear to ear so that the hair will cover the scar and make it less visible. The incision is made to the bone only, leaving the underlying meninges intact. The top half of the eye sockets is cut loose. Once the eye socket section has been cut loose, a vertical incision is made in the midline, and the whole section of the eye socket is bent outwards in order to correct the pointed shape of the forehead. Because the section is now too wide, a wedge needs to be cut on either side to allow the section to fit into the skull.

Maxillo-mandibular Advancement (MMA) is a procedure where both the upper and lower jaws are surgically moved forward (Lefort 1 osteotomy of the maxilla & saggital split advancement of the mandible). Although this is one of the most aggressive surgical procedures for the treatment of sleep apnea, it is also the most successful. Most studies show successful treatment of sleep apnea in greater than 90%.

When the bones of the upper and lower jaw are surgically advanced, the soft tissues of the tongue and palate are also moved forward which opens the upper airway. Since the upper and lower teeth are moved the same amount, the bite would be similar before and after operation, however pre-operative orthodontic work may be required.
The MMA alters, and may enhance appearance. It is not disfiguring and there are no external scars. The operation is accomplished through the mouth. The jaws may be briefly wired closed or kept closed using tiny elastic bands following the operation. The procedure is technically involved with the potential for complications, but most patients recover remarkably well from this surgery. It is generally reserved for otherwise healthy patients.