{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:46:45Z","timestamp":1790642805089,"version":"4.1.0"},"reference-count":76,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,5]]},"abstract":"\n OBJECT<\/jats:title>\n Current craniosynostosis procedures can result in complications due to absorbable plates and screws or other specialized expensive hardware. The authors propose the cranial orbital buttress (COB) technique of frontoorbital remodeling for metopic and unicoronal synostoses, wherein no plates or screws are used. They hypothesize that, with this technique, aesthetically acceptable outcomes for unicoronal and metopic synostosis can be achieved. In this article, they present this technique and compare the results with current frontoorbital remodeling practices.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors conducted a retrospective chart review of cases in which patients with nonsyndromic unicoronal or metopic synostosis underwent cranio-orbital surgery at their institution from 1985 through 2009. Operative parameters, surgical variations, and complications were analyzed. The COB technique uses a 1-piece switch, hemiforeheads, or multiple pieces for forehead remodeling. The supraorbital bar is reconstructed in patients with metopic synostosis using a double wedge or greenstick fracture technique, and in patients with unicoronal synostosis a hinge procedure based on a 1.5-orbital osteotomy is used. The supraorbital bar is advanced and supported in place by bone graft(s) inserted at the lateral aspect(s) of the orbit(s) to form a buttress, with fixation done using absorbable sutures.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 79 cases met the criteria for inclusion in the study. Twenty-nine patients had metopic synostosis, 3 had combined metopic and sagittal synostoses, and 47 had unicoronal synostosis. The patients\u2019 mean age at surgery was 11.4 \u00b1 10.1 months and the mean operative time was 183.4 \u00b1 41.0 minutes. The mean length of hospital stay was 3.7 \u00b1 1.2 days. The mean blood loss was 150.0 \u00b1 125.6 ml, and 33% of patients required a blood transfusion (mean volume 206.9 \u00b1 102.3 ml). In metopic synostosis, hemiforeheads were used most often (24\/29, 83%), and the supraorbital bar was remodeled using a bilateral intracranial orbital osteotomy followed by a double wedge modification (23\/29, 79%) or a greenstick fracture (4\/29 14%) for milder cases. Forehead remodeling for unicoronal synostosis was by a forehead switch (39\/47, 83%) and the supraorbital bar was remodeled using a 1.5-orbital intracranial orbital osteotomy (34\/47, 72%) such that the bar was advanced on the abnormal side and hinged at the midline of the normal orbit. Perioperative complications occurred in 19% of cases and included dural tears (16%), inconsequential subdural hematoma (1.3%), and nasal greenstick fracture (1.3%). The total reoperation rate was 7.6% (cranioplasties for irregular contours, 6.3%; scar revision, 1.3%).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The COB remodeling technique is simple and efficient, gives acceptable outcomes, and is less resource intensive than previous techniques reported in the literature.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.2.focus14844","type":"journal-article","created":{"date-parts":[[2015,5,1]],"date-time":"2015-05-01T03:36:59Z","timestamp":1430451419000},"page":"E4","source":"Crossref","is-referenced-by-count":15,"title":["The cranial orbital buttress technique for nonsyndromic unicoronal and metopic craniosynostosis"],"prefix":"10.3171","volume":"38","author":[{"given":"Shane K. F.","family":"Seal","sequence":"first","affiliation":[{"name":"Divisions of Plastic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Steinbok","sequence":"additional","affiliation":[{"name":"Neurosurgery, Department of Surgery, University of British Columbia and British Columbia Children\u2019s Hospital, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas J.","family":"Courtemanche","sequence":"additional","affiliation":[{"name":"Divisions of Plastic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1-focus14844","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis","volume":"31","author":"Berry-Candelario","year":"2011"},{"key":"b2-focus14844","series-title":"Plast Reconstr Surg","first-page":"952","article-title":"Functional outcome after surgery for trigonocephaly","volume":"102","author":"Bottero","year":"1998"},{"key":"b3-focus14844","series-title":"Childs Nerv Syst","first-page":"1375","article-title":"The Christmas tree foreheadplasty: a novel technique used in combination with a bandeau for fronto-orbital remodelling in craniosynostosis","volume":"28","author":"Britto","year":"2012"},{"key":"b4-focus14844","series-title":"Aust N Z J Surg","first-page":"482","article-title":"Experimental calvarial growth disturbance by micro-plate and screw fixation","volume":"62","author":"Courtemanche","year":"1992"},{"key":"b5-focus14844","series-title":"Childs Nerv Syst","first-page":"2189","article-title":"The shell technique bilateral fronto-orbital reshaping in trigonocephaly","volume":"29","author":"Di Rocco","year":"2013"},{"key":"b6-focus14844","series-title":"Plast Reconstr Surg","first-page":"850","article-title":"Resorbable PLLA-PGA plate and screw fixation in pediatric craniofacial surgery: clinical experience in 1883 patients","volume":"114","author":"Eppley","year":"2004"},{"key":"b7-focus14844","series-title":"Childs Nerv Syst","first-page":"2195","article-title":"Endoscope-assisted repair of metopic synostosis","volume":"29","author":"Er\u015fahin","year":"2013"},{"key":"b8-focus14844","series-title":"Childs Nerv Syst","first-page":"1421","article-title":"Complications in the surgical treatment of craniosynostosis and craniofacial syndromes: apropos of 306 transcranial procedures","volume":"24","author":"Esparza","year":"2008"},{"key":"b9-focus14844","series-title":"J Craniofac Surg","first-page":"1180","article-title":"Beyond the bandeau: 4 variations on fronto-orbital advancements","volume":"19","author":"Fearon","year":"2008"},{"key":"b10-focus14844","series-title":"Cir Pediatr","first-page":"33","article-title":"Endoscopically assisted fronto-orbitary correction in trigonocephaly","volume":"20","author":"Hinojosa","year":"2007"},{"key":"b11-focus14844","series-title":"Ann Plast Surg","first-page":"447","article-title":"Fronto-orbital advancement by distraction: the latest modification","volume":"49","author":"Hirabayashi","year":"2002"},{"key":"b12-focus14844","series-title":"J Neurosurg","first-page":"376","article-title":"Lateral canthal advancement of the supraorbital margin. A new corrective technique in the treatment of coronal synostosis","volume":"45","author":"Hoffman","year":"1976"},{"key":"b13-focus14844","series-title":"Pediatrics","first-page":"97","article-title":"Early management of craniosynostosis using endoscopic-assisted strip craniectomies and cranial orthotic molding therapy","volume":"110","author":"Jimenez","year":"2002"},{"key":"b14-focus14844","series-title":"J Plast Surg Hand Surg","first-page":"63","article-title":"Correction of hypotelorism in isolated metopic synostosis","volume":"48","author":"Maltese","year":"2014"},{"key":"b15-focus14844","series-title":"Ann Plast Surg","first-page":"43","article-title":"Craniofacial surgery for craniosynostosis improves facial growth: a personal case review","volume":"14","author":"Marchac","year":"1985"},{"key":"b16-focus14844","series-title":"Ann Chir Plast","first-page":"121","article-title":"The \u201cfloating forehead\u201d. Early treatment of craniofacial stenosis","volume":"24","author":"Marchac","year":"1979"},{"key":"b17-focus14844","series-title":"Br J Plast Surg","first-page":"1","article-title":"Experience with the \u201cfloating forehead.\u201d","volume":"41","author":"Marchac","year":"1988"},{"key":"b18-focus14844","series-title":"Plast Reconstr Surg","first-page":"379e","article-title":"Temporal hollowing following coronal incision: a prospective, randomized, controlled trial","volume":"121","author":"Matic","year":"2008"},{"key":"b19-focus14844","series-title":"J Craniofac Surg","first-page":"980","article-title":"Prevention of temporal depression that follows fronto-orbital advancement for craniosynostosis","volume":"17","author":"Oh","year":"2006"},{"key":"b20-focus14844","series-title":"Plast Reconstr Surg","first-page":"2032","article-title":"Management of craniosynostosis","volume":"111","author":"Panchal","year":"2003"},{"key":"b21-focus14844","series-title":"Childs Nerv Syst","first-page":"2171","article-title":"Parallel angulated frontal bone slat cuts for treatment of metopic synostosis and other frontal skull deformities: the \u201ccathedral dome procedure.\u201d","volume":"29","author":"Pang","year":"2013"},{"key":"b22-focus14844","series-title":"J Craniofac Surg","first-page":"65","article-title":"Craniosynostosis: a single institution\u2019s outcome assessment from surgical reconstruction","volume":"19","author":"Pearson","year":"2008"},{"key":"b23-focus14844","series-title":"Childs Nerv Syst","first-page":"2183","article-title":"Trigonocephaly: Lille\u2019s surgical technique","volume":"29","author":"Pellerin","year":"2013"},{"issue":"4 Suppl","key":"b24-focus14844","series-title":"Plast Reconstr Surg","first-page":"1","article-title":"MOC-PS(SM) CME article: management considerations in the treatment of craniosynostosis","volume":"121","author":"Persing","year":"2008"},{"key":"b25-focus14844","series-title":"Childs Nerv Syst","first-page":"645","article-title":"Management of craniosynostoses","volume":"16","author":"Renier","year":"2000"},{"key":"b26-focus14844","series-title":"J Craniofac Surg","first-page":"926","article-title":"Maximizing results in craniofacial surgery with bioresorbable fixation devices","volume":"18","author":"Sanger","year":"2007"},{"key":"b27-focus14844","series-title":"Plast Reconstr Surg","first-page":"251e","article-title":"Long-term results following fronto-orbital reconstruction in nonsyndromic unicoronal synostosis","volume":"121","author":"Selber","year":"2008"},{"key":"b28-focus14844","series-title":"Childs Nerv Syst","first-page":"433","article-title":"Analysis of pre- and post-operative symptoms of patients with mild trigonocephaly using several developmental and psychological tests","volume":"31","author":"Shimoji","year":"2014"},{"key":"b29-focus14844","series-title":"Childs Nerv Syst","first-page":"445","article-title":"Minimizing blood transfusions in the surgical correction of coronal and metopic craniosynostosis","volume":"20","author":"Steinbok","year":"2004"},{"key":"b30-focus14844","series-title":"Childs Nerv Syst","first-page":"1149","article-title":"Split calvarial bone grafting in patients less than 1 year of age: technical note and use in craniofacial surgery for craniosynostosis","volume":"27","author":"Steinbok","year":"2011"},{"key":"b31-focus14844","series-title":"Plast Reconstr Surg","first-page":"176e","article-title":"A new approach for the treatment of unilateral coronal synostosis based on distraction osteogenesis","volume":"134","author":"Taylor","year":"2014"},{"key":"b32-focus14844","series-title":"Ann Chir Plast","first-page":"273","article-title":"Total facial osteotomy. Crouzon\u2019s syndrome, Apert\u2019s syndrome: oxycephaly, scaphocephaly, turricephaly","volume":"12","author":"Tessier","year":"1967"},{"key":"b33-focus14844","series-title":"Acta Paediatr","first-page":"1185","article-title":"Evaluation and management of nonsyndromic craniosynostosis","volume":"100","author":"Ursitti","year":"2011"},{"key":"b34-focus14844","series-title":"Plast Reconstr Surg","article-title":"The importance of timing in optimizing cranial vault remodeling in syndromic craniosynostosis","author":"Utria","year":"2014"},{"key":"b35-focus14844","series-title":"Childs Nerv Syst","first-page":"1359","article-title":"Metopic synostosis","volume":"28","author":"van der Meulen","year":"2012"},{"key":"b36-focus14844","series-title":"Plast Reconstr Surg","first-page":"195","article-title":"Craniosynostosis: an analysis of the timing, treatment, and complications in 164 consecutive patients","volume":"80","author":"Whitaker","year":"1987"},{"key":"b37-focus14844","series-title":"Plast Reconstr Surg","first-page":"561","article-title":"Improvements in craniofacial reconstruction: methods evolved in 235 consecutive patients","volume":"65","author":"Whitaker","year":"1980"},{"key":"b38-focus14844","series-title":"Plast Reconstr Surg","first-page":"575","article-title":"Early surgery for isolated craniofacial dysostosis. Improvement and possible prevention of increasing deformity","volume":"60","author":"Whitaker","year":"1977"},{"issue":"2","key":"b1-focus14844","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis","volume":"31","author":"Berry-Candelario","year":"2011"},{"key":"b2-focus14844","series-title":"Plast Reconstr Surg","first-page":"952","article-title":"Functional outcome after surgery for trigonocephaly","volume":"102","author":"Bottero","year":"1998"},{"key":"b3-focus14844","series-title":"Childs Nerv Syst","first-page":"1375","article-title":"The Christmas tree foreheadplasty: a novel technique used in combination with a bandeau for fronto-orbital remodelling in craniosynostosis","volume":"28","author":"Britto","year":"2012"},{"key":"b4-focus14844","series-title":"Aust N Z J Surg","first-page":"482","article-title":"Experimental calvarial growth disturbance by micro-plate and screw fixation","volume":"62","author":"Courtemanche","year":"1992"},{"key":"b5-focus14844","series-title":"Childs Nerv Syst","first-page":"2189","article-title":"The shell technique bilateral fronto-orbital reshaping in trigonocephaly","volume":"29","author":"Di Rocco","year":"2013"},{"key":"b6-focus14844","series-title":"Plast Reconstr Surg","first-page":"850","article-title":"Resorbable PLLA-PGA plate and screw fixation in pediatric craniofacial surgery: clinical experience in 1883 patients","volume":"114","author":"Eppley","year":"2004"},{"key":"b7-focus14844","series-title":"Childs Nerv Syst","first-page":"2195","article-title":"Endoscope-assisted repair of metopic synostosis","volume":"29","author":"Er\u015fahin","year":"2013"},{"key":"b8-focus14844","series-title":"Childs Nerv Syst","first-page":"1421","article-title":"Complications in the surgical treatment of craniosynostosis and craniofacial syndromes: apropos of 306 transcranial procedures","volume":"24","author":"Esparza","year":"2008"},{"key":"b9-focus14844","series-title":"J Craniofac Surg","first-page":"1180","article-title":"Beyond the bandeau: 4 variations on fronto-orbital advancements","volume":"19","author":"Fearon","year":"2008"},{"key":"b10-focus14844","series-title":"Cir Pediatr","first-page":"33","article-title":"Endoscopically assisted fronto-orbitary correction in trigonocephaly","volume":"20","author":"Hinojosa","year":"2007"},{"key":"b11-focus14844","series-title":"Ann Plast Surg","first-page":"447","article-title":"Fronto-orbital advancement by distraction: the latest modification","volume":"49","author":"Hirabayashi","year":"2002"},{"key":"b12-focus14844","series-title":"J Neurosurg","first-page":"376","article-title":"Lateral canthal advancement of the supraorbital margin. A new corrective technique in the treatment of coronal synostosis","volume":"45","author":"Hoffman","year":"1976"},{"key":"b13-focus14844","series-title":"Pediatrics","first-page":"97","article-title":"Early management of craniosynostosis using endoscopic-assisted strip craniectomies and cranial orthotic molding therapy","volume":"110","author":"Jimenez","year":"2002"},{"key":"b14-focus14844","series-title":"J Plast Surg Hand Surg","first-page":"63","article-title":"Correction of hypotelorism in isolated metopic synostosis","volume":"48","author":"Maltese","year":"2014"},{"key":"b15-focus14844","series-title":"Ann Plast Surg","first-page":"43","article-title":"Craniofacial surgery for craniosynostosis improves facial growth: a personal case review","volume":"14","author":"Marchac","year":"1985"},{"key":"b16-focus14844","series-title":"Ann Chir Plast","first-page":"121","article-title":"The \u201cfloating forehead\u201d. Early treatment of craniofacial stenosis","volume":"24","author":"Marchac","year":"1979"},{"key":"b17-focus14844","series-title":"Br J Plast Surg","first-page":"1","article-title":"Experience with the \u201cfloating forehead.\u201d","volume":"41","author":"Marchac","year":"1988"},{"key":"b18-focus14844","series-title":"Plast Reconstr Surg","first-page":"379e","article-title":"Temporal hollowing following coronal incision: a prospective, randomized, controlled trial","volume":"121","author":"Matic","year":"2008"},{"key":"b19-focus14844","series-title":"J Craniofac Surg","first-page":"980","article-title":"Prevention of temporal depression that follows fronto-orbital advancement for craniosynostosis","volume":"17","author":"Oh","year":"2006"},{"key":"b20-focus14844","series-title":"Plast Reconstr Surg","first-page":"2032","article-title":"Management of craniosynostosis","volume":"111","author":"Panchal","year":"2003"},{"key":"b21-focus14844","series-title":"Childs Nerv Syst","first-page":"2171","article-title":"Parallel angulated frontal bone slat cuts for treatment of metopic synostosis and other frontal skull deformities: the \u201ccathedral dome procedure.\u201d","volume":"29","author":"Pang","year":"2013"},{"key":"b22-focus14844","series-title":"J Craniofac Surg","first-page":"65","article-title":"Craniosynostosis: a single institution\u2019s outcome assessment from surgical reconstruction","volume":"19","author":"Pearson","year":"2008"},{"key":"b23-focus14844","series-title":"Childs Nerv Syst","first-page":"2183","article-title":"Trigonocephaly: Lille\u2019s surgical technique","volume":"29","author":"Pellerin","year":"2013"},{"issue":"4 Suppl","key":"b24-focus14844","series-title":"Plast Reconstr Surg","first-page":"1","article-title":"MOC-PS(SM) CME article: management considerations in the treatment of craniosynostosis","volume":"121","author":"Persing","year":"2008"},{"key":"b25-focus14844","series-title":"Childs Nerv Syst","first-page":"645","article-title":"Management of craniosynostoses","volume":"16","author":"Renier","year":"2000"},{"key":"b26-focus14844","series-title":"J Craniofac Surg","first-page":"926","article-title":"Maximizing results in craniofacial surgery with bioresorbable fixation devices","volume":"18","author":"Sanger","year":"2007"},{"key":"b27-focus14844","series-title":"Plast Reconstr Surg","first-page":"251e","article-title":"Long-term results following fronto-orbital reconstruction in nonsyndromic unicoronal synostosis","volume":"121","author":"Selber","year":"2008"},{"key":"b28-focus14844","series-title":"Childs Nerv Syst","first-page":"433","article-title":"Analysis of pre- and post-operative symptoms of patients with mild trigonocephaly using several developmental and psychological tests","volume":"31","author":"Shimoji","year":"2014"},{"key":"b29-focus14844","series-title":"Childs Nerv Syst","first-page":"445","article-title":"Minimizing blood transfusions in the surgical correction of coronal and metopic craniosynostosis","volume":"20","author":"Steinbok","year":"2004"},{"key":"b30-focus14844","series-title":"Childs Nerv Syst","first-page":"1149","article-title":"Split calvarial bone grafting in patients less than 1 year of age: technical note and use in craniofacial surgery for craniosynostosis","volume":"27","author":"Steinbok","year":"2011"},{"key":"b31-focus14844","series-title":"Plast Reconstr Surg","first-page":"176e","article-title":"A new approach for the treatment of unilateral coronal synostosis based on distraction osteogenesis","volume":"134","author":"Taylor","year":"2014"},{"key":"b32-focus14844","series-title":"Ann Chir Plast","first-page":"273","article-title":"Total facial osteotomy. 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