[The subperiosteal subtemporal approach in the surgical treatment of craniostenosis. Apropos of 9 cases].

The authors describe the approach consisting of direct subperiosteal, subtemporal cleavage based on existing anatomical continuity between the subtemporal plane and the cranial periosteum in young children. This allows for downward cleavage up to the level of the malar processes, for dissecting both orbits as well as the external columns. Frontoorbital remodeling which is needed for management of craniostenosis may be readily carried out with the improved field of vision. It will suffice, then, to depress the scalp and to suture the skin to obtain perfect repositioning of the temporal muscle, remaining one piece with the cutaneous plane and maintained steady thanks to the salvaged continuity of the periosteum with the subtemporal plane. Utilization of this approach avoids having to cleave the temporal muscle superficially, to section and then reinsert it to the bony frontoorbital fascia after remodeling, thereby constituting a simplified technique of craniostenosis management. Experience gained in craniostenotic children treated via this direct subperiosteal subtemporal approach opens the way for possible applications in adult traumatology patients, as well as for the constitution of unilateral pterion flaps without jeopardizing the frontal ramus of the facial nerve.