Beyond the bandeau: 4 variations on fronto-orbital advancements.

The ubiquitous tongue and groove osteotomy remains the standard for treating the anterior craniosynostoses, despite the fact that significant variations in three-dimensional fronto-orbital dystopia can occur with various sutural fusions. Four variations on bandeau design are described that allow surgeons to go beyond a simple forward advancements toward a precise three-dimensional positioning (forward advancement, vertical repositioning, and medial narrowing), or allowing the avoidance of sinus crossing osteotomies that can potentially reduce infection risk. These osteotomy designs permit more accurate positioning of the supraorbits; they are also structurally and inherently stable, offering surgeons greater latitude in fixation techniques.