Surgical intervention is now usually planned for 8 or 9 months of age. During this early surgery to release the prematurely fused sutures the forehead is often brought forward and the eyebrow ridge is remodeled to protect the eyes and give the child a more normal appearance. As the skull grows, the upper and lower thirds of the face tend to grow at normal rates, but the middle third of the face grows slower, resulting in a more pronounced retrusion over time. The fusion of the fingers and toes is called syndactyly . It always involves fusion of the soft tissues of the first, middle, and ring fingers, and often there is fusion of the bones themselves.
Joint mobility is usually nonexistent past the first joint.
The thumb may be fused into the hand or may be free. Surgery is used to separate the fingers to obtain the highest degree of functionality, and may or may not ultimately result in five digits on each hand. This varies according to the degree of malformation and the skill of the surgeon. It is thought that of the two genetic mutations responsible for Apert Syndrome the most common Ser252Trp is associated with higher incidence of cleft palate and only Class I or II hand malformations, in contrast to the Pro253Arg mutation being linked to less severe craniofacial abnormalities, but the more severe Class III hand malformation. As one surgeon put it to me, you either get bad head, good hands or vice versa.