Fronto-orbital Advancement

Unilateral coronal synostosis, bilateral coronal synostosis and metopic synostosis all cause changes in the shape of the forehead and upper portion of the eye socket (orbit) that cause an abnormal appearance. Fronto-orbital advancement (FOA) is the surgical procedure used to reshape and reposition the forehead and upper portion of the orbits. While the deformity of the forehead and orbit varies based upon which cranial suture is affected, the ultimate goal of the fronto-orbital advancement is the same in each case. The goal of the FOA procedure in all cases is to overcorrect the position and contour of the upper portion of the eye socket(s) and forehead. In order to have a normal appearance when the child's skull is fully grown, we must place the bones of the forehead and eye socket position in a more forward position for coronal synostosis and wider position for metopic synostosis. The infant's appearance immediately after surgery does not look normal for their age, but the children grow into the overcorrection in next 1-2 years after surgery. If the forehead and upper eye socket are not overcorrected, the face and skull will initially look normal but will have an abnormal appearance (similar to the original head shape) when the child is fully grown. Below are some examples of patients before and after fronto-orbital advancement.

 This baby has left coronal synostosis. Note the flattening of the left forehead and upper portion of the eye socket (orbit). He underwent FOA at 10 months of age.

This baby has left coronal synostosis. Note the flattening of the left forehead and upper portion of the eye socket (orbit). He underwent FOA at 10 months of age.

 This is the same child 4 months after his FOA. Note that the left forehead and upper eye socket have been moved much farther forward than the right side. This is because the closed coronal suture on the left side will not provide the forward growth that the right open coronal suture will.

This is the same child 4 months after his FOA. Note that the left forehead and upper eye socket have been moved much farther forward than the right side. This is because the closed coronal suture on the left side will not provide the forward growth that the right open coronal suture will.

 This is the same patient at age 2 years old. He is more than a year out from his FOA. Note that he is still slightly overcorrected, but he has largely grown into his overcorrection already. There is a balanced look to the position and shape of both the forehead and upper eye socket. 

This is the same patient at age 2 years old. He is more than a year out from his FOA. Note that he is still slightly overcorrected, but he has largely grown into his overcorrection already. There is a balanced look to the position and shape of both the forehead and upper eye socket. 

 These are side views of the patient above before FOA. Note the the forehead and upper eye socket are much farther forward on the child's right side, while the left side is much flatter. Note that the upper eye socket on the left is abnormally positioned behind the eye.

These are side views of the patient above before FOA. Note the the forehead and upper eye socket are much farther forward on the child's right side, while the left side is much flatter. Note that the upper eye socket on the left is abnormally positioned behind the eye.

  These are side views of the patient above 14 months after FOA. Note the symmetric shape and position of the forehead and upper eye socket.

These are side views of the patient above 14 months after FOA. Note the symmetric shape and position of the forehead and upper eye socket.

  The pictures on the left above show a patient with bilateral coronal synostosis 2 years after posterior cranial vault distraction, just before her FOA at age 3 years old. The images on the right are 6 months after the reshaping of her forehead and upper eye sockets (orbits) with fronto-orbital advancement (FOA) performed at age 3 years old. Note the improved contour of the forehead from broad and flat to narrower and more rounded. The upper portion of the eye sockets have been moved forward and downward.

The pictures on the left above show a patient with bilateral coronal synostosis 2 years after posterior cranial vault distraction, just before her FOA at age 3 years old. The images on the right are 6 months after the reshaping of her forehead and upper eye sockets (orbits) with fronto-orbital advancement (FOA) performed at age 3 years old. Note the improved contour of the forehead from broad and flat to narrower and more rounded. The upper portion of the eye sockets have been moved forward and downward.

  The pi  ctures above show the   side views of the same patient before and after her FOA. The images on   the right are 6 months after the r  eshaping of her forehead and upper eye sockets (orbits) with fronto-orbital advancement (FOA) performed at age 3 years old. Note the improved contour of the forehead from broad and flat to more rounded. The upper portion of the eye sockets have been moved forward and downward. The upper portion of the orbit now sits in front of the eyes in a more normal position.

The pictures above show the side views of the same patient before and after her FOA. The images on the right are 6 months after the reshaping of her forehead and upper eye sockets (orbits) with fronto-orbital advancement (FOA) performed at age 3 years old. Note the improved contour of the forehead from broad and flat to more rounded. The upper portion of the eye sockets have been moved forward and downward. The upper portion of the orbit now sits in front of the eyes in a more normal position.