Abandoning the Supraorbital Bandeau in Anterior Craniosynostosis Repairs, for a Single-Segment Reconstruction

Plast Reconstr Surg. 2018 Sep;142(3):334e-341e. doi: 10.1097/PRS.0000000000004649.


Background: Following correction of anterior sutural fusions, long-term forehead irregularities may arise. Based on the premise that frontal reconstructions using a seamless construct might produce better long-term aesthetic results, the supraorbital bandeau was abandoned for a single-piece frontal reconstruction. The purpose of this review was to compare outcomes and complications between children who underwent reconstruction with the traditional supraorbital bandeau and those who underwent reconstruction with a single bony segment.

Methods: A retrospective sequential chart review was performed of all children undergoing anterior sutural fusion repairs to compare supraorbital bandeau to single-segment reconstructions. Length of surgery, blood loss, hospital stay, and complications were assessed. Aesthetic outcomes and reoperation rates were also examined.

Results: Over 10 years, 199 patients with anterior sutural fusions underwent correction: 124 with a single-piece frontal reconstruction and 75 with traditional supraorbital bandeaus. Outcome analyses revealed no significant differences between techniques with respect to blood loss, surgical times, complication rates, and hospital length of stay. A preliminary analysis suggested lower reoperation rates (0 percent versus 2.7 percent) and more favorable aesthetic rankings for those treated with a single segment, although the follow-up for this group was significantly shorter compared with those treated with a supraorbital bandeau (16 months versus 43 months).

Conclusions: Abandoning the traditional supraorbital bandeau for a simplified single-segment frontal reconstruction has the potential to result in improved forehead aesthetics, although longer term evaluations are needed. This review suggests that this technical variation does not appear to be associated with longer surgical times, increased blood loss, or higher complication rates.

Clinical question/level of evidence: Therapeutic, III.

Publication types

  • Review

MeSH terms

  • Blood Loss, Surgical / statistics & numerical data
  • Child
  • Craniosynostoses / surgery*
  • Esthetics
  • Follow-Up Studies
  • Frontal Bone / abnormalities
  • Frontal Bone / surgery*
  • Humans
  • Length of Stay / statistics & numerical data
  • Operative Time
  • Orthopedic Procedures / adverse effects
  • Orthopedic Procedures / methods*
  • Plastic Surgery Procedures / adverse effects
  • Plastic Surgery Procedures / methods*
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Treatment Outcome