*3.1.7 Pre-operative preparation*

Other pre-surgical preparation includes patient optimization prior to surgery via comprehensive in ward assessment by paediatric respiratory physician and anaesthetist.

Patient's CT image can be used for surgical simulation using surgical software and utilized for 3D model fabrication to optimize the corrective surgery outcomes as shown in **Figure 4**. The technology provides precision and significantly reduces the operating hours thus minimizing the potential complication such as intraoperative bleeding [21–24]. All patients in the authors' center had their 3D skull biomodel fabricated to allow surgical simulation and vector determination to optimize the outcome of surgery. The pre-bending of the distractor footplates for the internal device and presurgical simulation proved critical because it contributed to the precision of device fixation and correct segmental movement to ensure a favorable final outcome and decrease operating time.

The selection of devices is based on device suitability and functional indications. Increased ICP was assessed by history, presence of signs or symptoms, imaging analysis, and ophthalmologic assessment. For the eye, the patients' ability to achieve eyelid closure was assessed and documented and supplemented with eye examinations that included optic disc condition and cup-to-disc ratio through funduscopy. Airway function was assessed by polysomnography and digital airway assessment.

Intra-operative complications should be anticipated thus preparation should include paediatric intensive care unit booking, blood cross-matched and reserve for transfusion as well as appropriate drug prescription.

**135**

*Craniofacial Corrective Surgery in Syndromic Craniosynostosis*

When certain corrective surgery has been agreed by the multi-disciplinary team, consent should be clear and comprehensive with consideration of various complications ranging from mild to severe degree, at intra-operative and post-

Following comprehensive assessment from the craniofacial team, the choice of surgery basically depends on the aim, condition of the patient, skill of the surgeons and the facility. Hariri et al. [25] proposed for a protocol to indicate the type of intervention based on the aim of the functional rehabilitation. The protocol explained on the extend of surgical treatment depending on the patient's severity, age as well as whether it can be done in stages or in combination to

In multiple aims for rehabilitation in very young patient for example, increased ICP with hydrocephalus would necessitate less extensive surgical intervention such as ventriculoperitoneal (VP) shunting, while severe orbital proptosis might indicate temporary tarsorraphy, and respiratory difficulty would necessitate a continuous airway pressure device, a nasal stent, or a tracheostomy depending on the severity and the specific anatomic obstruction. More extensive surgical procedures are usu-

Posterior cranial vault expansion is usually indicated in increased in ICP cases without other functional issues when the patient's age is more suitable [26, 27]. The aim is to increase the cranial volume to accommodate for the brain growth whilst

Increased ICP with orbital proptosis might require fronto-orbital advancement with or without cranioplasty, and increased ICP in the presence of orbital proptosis and hypoplastic maxilla might require a monobloc as practiced in the authors' center. Surgery can be performed conventionally or combined with distraction osteogenesis (DO) technique, which is indicated for superior structural expansion and achieving simultaneous new histogenesis compared with conventional surgical procedures [28]. The application of DO in treating craniofacial deformity was first reported in 1992 [29]. Since then, the benefits of this technique in treating syndromic craniosynostosis as reported in the literature are similar to those in the present study, which

ally deferred up to certain age to reduce possibility of complications.

*Simulation of the surgical procedures using reconstructed 3D STL model from the CT scan.*

*3.2.2 Fronto orbital advancement and Monobloc Le Fort III advancement*

*DOI: http://dx.doi.org/10.5772/intechopen.94584*

**3.2 Surgical techniques and its application**

*3.2.1 Posterior vault distraction/expansion*

reducing the intra cranial pressure.

operative phase.

**Figure 4.**

address the issues.

*Craniofacial Corrective Surgery in Syndromic Craniosynostosis DOI: http://dx.doi.org/10.5772/intechopen.94584*

*Spina Bifida and Craniosynostosis - New Perspectives and Clinical Applications*

the analysis of CT scan.

*3.1.6 Airway assessment*

obstructive sleep apnea (OSA).

*3.1.7 Pre-operative preparation*

*Airway assessment using software and CT scan.*

**Figure 3.**

final outcome and decrease operating time.

transfusion as well as appropriate drug prescription.

pressure. Tonometry can be performed to measure the intraocular pressure.

Assessment of the volume of eye sockets is also important and can be conducted via

For the airway, endoscopic examination is often performed to determine the cause of airway obliteration. The cause can either be due to soft tissue or hard tissue or both. Specific recognition of the anatomical restriction allows the surgical team to decide on the most ideal corrective surgical intervention such as shown in **Figure 3**. As most syndromic craniosynostosis patients are classically presented with midface hypoplasia, polysomnography (PSG) is the gold standard to diagnose

Other pre-surgical preparation includes patient optimization prior to surgery via comprehensive in ward assessment by paediatric respiratory physician and anaesthetist. Patient's CT image can be used for surgical simulation using surgical software and utilized for 3D model fabrication to optimize the corrective surgery outcomes as shown in **Figure 4**. The technology provides precision and significantly reduces the operating hours thus minimizing the potential complication such as intraoperative bleeding [21–24]. All patients in the authors' center had their 3D skull biomodel fabricated to allow surgical simulation and vector determination to optimize the outcome of surgery. The pre-bending of the distractor footplates for the internal device and presurgical simulation proved critical because it contributed to the precision of device fixation and correct segmental movement to ensure a favorable

The selection of devices is based on device suitability and functional indications.

Increased ICP was assessed by history, presence of signs or symptoms, imaging analysis, and ophthalmologic assessment. For the eye, the patients' ability to achieve eyelid closure was assessed and documented and supplemented with eye examinations that included optic disc condition and cup-to-disc ratio through funduscopy. Airway function was assessed by polysomnography and digital airway assessment. Intra-operative complications should be anticipated thus preparation should include paediatric intensive care unit booking, blood cross-matched and reserve for

**134**

When certain corrective surgery has been agreed by the multi-disciplinary team, consent should be clear and comprehensive with consideration of various complications ranging from mild to severe degree, at intra-operative and postoperative phase.

**Figure 4.** *Simulation of the surgical procedures using reconstructed 3D STL model from the CT scan.*
