At UPMC Children's Hospital of Pittsburgh, we believe parents and guardians can contribute to the success of this surgery and invite you to participate. Please read the following information to learn about the surgery and how you can help.
What Is Fronto-Orbital Advancement?
For moderate to severe cases of metopic craniosynostosis or coronal craniosynostosis, one of the surgeries we perform is called a fronto-orbital advancement.
Fronto-orbital advancement is a surgery used to reshape and reposition the bones of the forehead and orbits. The surgery is typically performed around 12 months of age.
A “zigzag" or bicoronal incision is made on the top of head from ear-to ear. This makes the scar less conspicuous. The goal is to restore normal contour. UPMC Children's plastic surgeons and neurosurgeons perform this surgery.
The appearance change is immediate. The brow can look “angry" or overcorrected that they grow into with time. The procedure takes five to six hours.
What Are the Risks Associated with Fronto-Orbial Advancement?
Risks include but are not limited to the following:
- Bleeding. Patients may receive blood intraoperatively.
- Infection. IV antibiotics used during inpatient stay to decrease risk.
- Damage to underlying structures.
- Calvarial defects.
- Need for additional surgery.
Before the Surgery: Pre-Op Office Visit
- CT scan of head.
- Discussion with surgeon/APP.
- Lab work: CBC, BMP, Clotting studies, type and screen, hold 2 units of PRBC
- No NSAIDS two weeks before the surgery, call with new-onset illness.
Home Preparation
- Typically you will receive a call between 1 and 5 p.m.
- For general anesthesia: NPO (Nothing by mouth) fulls/solids (this includes milk, candy, gum) AFTER midnight.
- Breastfed babies: NPO 4 hours prior, plain breast milk.
- Clear liquids NPO 3 hours prior (clear liquids include water, apple juice, and Pedialyte®).
- Plain formula NPO 6 hours prior, not thickened.
- No solids after midnight!
Day of Surgery
- Park in the Penn Garage. Take the Grape elevator to 4th floor to check in at Same Day Surgery.
- Arrival: 1.5 hours prior to surgery.
- You will meet with nurse, Dr. Goldstein, and anesthesia. You will review consents.
- Following surgery, the patient will go to a recovery area where nurses will call you when ready for family.
- Mom and dad can stay with patient overnight. No children may sleep over.
After Surgery
- 1-2 nights stay in ICU for lab monitoring, pain control, vitals monitoring.
- Transition to general plastic surgery floor one to two days post-op.
- Head dressing down two to three days post-op and JP drain out on day of discharge.
- CT scan head performed on day of discharge.
- Skin is closed with dissolvable sutures (these are sutures that do not need to be removed — they dissolve on their own).
We monitor vitals and pulse oximetry. They will have an IV for pain medication and transition to medications by mouth when eating/drinking.
- Typically a 2 or more night hospital stay
- When your child is recovering well, tolerating eating/drinking, and pain well controlled, then we prepare you for discharge.
- You will receive printed discharge information and prescriptions for bacitracin, Tylenol, and Roxicodone.
The eyes typically swell shut between first and second day post op. This typically subsides and they will reopen at day 3 to 5 post operatively. There will be a white head dressing placed that will be removed on post operative day 2 to 3. Some swelling and bruising is common after this surgery that improves with time. Incision site cared for starting on post operative day two with normal bathing (no submerging) and one week of bacitracin antibiotic ointment application.
Follow-Up Care
- Follow up within one to two weeks with Plastic Surgery and Neurosurgery.
- Our nurse can be reached at 412-692-6845.
- If after hours (before 7:30 a.m. and after 3:30 p.m.), Plastic Surgery can be paged through the UPMC Children's operator at 412-692-5325.
- If acute concerns, call 911 and report to Emergency Department.
- Most patients do not require additional large skull reshaping surgery. A minority of patients need a contouring procedure to address minor shape irregularities.
