Fronto-orbital advancement for Apert syndrome in infancy - Why?

The clinical outcome after infant fronto-orbital advancement in Apert syndrome has been reviewed. This procedure largely fails to achieve normalisation of forehead position and brow projection, and is associated with a high rate of repeat operations. Anomalies characteristic of the Apert craniofacial region (megalencephaly, midline calvarial defect) contribute to the inconsistency of this technique. By controlling the decompressive role of the midline bony defect, it may be possible to improve the outcome in infant fronto-orbital advancement. Alternatively, by delaying this surgery until age two to four years when the bony defect has closed, definitive cranial vault reshaping can be ensured.