Anterior two-thirds calvarial remodelling: operative technique for the correction of metopic synostosis in toddlers

Summary Background Premature closure of the metopic suture results in deformation of the anterior calvarium. Trigonocephaly is expressed in various forms – from a simple midline ridge of the forehead to a severe keel-shaped deformity – often requiring specific surgical correction for aesthetic impro...

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Bibliographic Details
Published in:Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2010-01, Vol.63 (1), p.36-41
Main Authors: Paik, Hyewon, Byeon, Jun Hee
Format: Article
Language:English
Subjects:
Biological and medical sciences
Bone Cements
Bone Transplantation
Calvarial remodelling
Child, Preschool
Cranial Sutures - abnormalities
Cranial Sutures - diagnostic imaging
Cranial Sutures - surgery
Craniosynostoses - diagnostic imaging
Craniosynostoses - surgery
Diseases of the osteoarticular system
Female
Humans
Infant
Korea
Male
Malformations and congenital and or hereditary diseases involving bones. Joint deformations
Malformations of the nervous system
Medical sciences
Metopic synostosis
Neurology
Osteotomy
Plastic Surgery
Postoperative Complications
Retrospective Studies
Skull - abnormalities
Skull - diagnostic imaging
Skull - surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Tomography, X-Ray Computed
Treatment Outcome
Trigonocephaly
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Summary:Summary Background Premature closure of the metopic suture results in deformation of the anterior calvarium. Trigonocephaly is expressed in various forms – from a simple midline ridge of the forehead to a severe keel-shaped deformity – often requiring specific surgical correction for aesthetic improvement and cognitive and linguistic function advancement. This article presents a surgical technique used over 5 years to treat trigonocephalic toddlers in Korea. Methods Retrospective analyses were performed on eight patients with metopic synostosis treated at St. Mary's Hospital (Seoul) during 2002–2006. The study included reviews of preoperative and postoperative computed tomography scans, operative techniques, clinical outcomes and complications. Operative techniques included fronto-orbital bandeau tilting after expansion with a midline wedge-bone graft, detriangulation of foreheads with an inward bending at lateral orbital wall, multiple zigzag osteotomy of frontal bone, barrel-stave osteotomy of parietal bone and the occasional application of calcium phosphate cement (BoneSource® , Leibinger Inc., Michigan, USA) to refine the forehead shape. Results The average age of the patients at time of surgery – due to late referral to medical care – was 25.1 months. Two patients had concomitant bicoronal synostosis requiring coronal suture resection with anterior two-thirds calvarial reconstruction. The central angle measurements improved from a preoperative average of 118° to 134°; interorbital distances widened from 18.8 mm to 20.9 mm. Mean follow-up was 2.6 years, and no neurological sequelae or other significant complications were encountered. Conclusions Moderate-to-severe trigonocephaly requires surgical correction involving anterior two-thirds calvarial remodelling with fronto-orbital advancement and frontal-bone remodelling. The described operative approach, especially in toddlers, minimises bone defects by adopting multiple zigzag osteotomy of the frontal bone. This modality results in significant improvements in skull form and high patient/parent satisfaction.
ISSN:1748-6815
1878-0539
DOI:10.1016/j.bjps.2008.08.076