Calvarial Osteotomies

The surgical procedures shown demonstrate a method of calvarial osteotomies used by the author in a systematic way in all types of synostosis and may be extended from the forehead procedure to a whole skull procedure, as needed. It can be applied to mild and severe forms of deformity and rarely needs a variation in osteotomy lines. The method is explained in full remodelling first. Then the surgery for the single-suture synostoses follows. Different types of forehead remodelling and vertex remodelling are demonstrated. The surgery of multiple syndromal and nonsyndromal synostoses is described. First, one-stage procedures—total remodelling in one session—are shown. This is followed by two stage procedures, anterior or posterior surgery first and the other one secondary. The procedures may be osteotomy and remodelling with osteosynthesis or distraction osteogenesis and the combinations. The option of surgery of synostosis and additional hypertelorism is demonstrated and finally a synostosis with an additional occipital encephalocele. Finally, forehead remodelling in the adult patient and augmentation with implants are discussed and demonstrated as well as correction of lid slant.