Comparing two fronto-orbital advancement strategies to treat trigonocephaly in metopic synostosis

BackgroundTrigonocephalic treatment entails frontoorbital reshaping of the forehead, increasing bitemporal dimensions, and advancing lateral orbits. Various techniques can achieve this, but no consensus exists regarding effects on long-term skull growth. Overcorrecting forehead dimensions is one strategy though preserving a vascularized fronto-orbital bar can influence future growth. We therefore seek to craniomorphologically compare fronto-orbital advancement (FOA), using bandeau widening and advancement, to a pedicled “tilt” procedure to assess whether adequate 3D remodeling is achieved.MethodsDemographic and computed tomographic data was recorded. Pre- and post-craniometric measurements were performed for the endocranial bifrontal angle, orbital plane angle, anterior advancement and the interzygomaticofrontal suture distance.Results40 CT scans were analyzed, with similar demographics. No perioperative complications were encountered. The endocranial bifrontal angle increased in the FOA (p = 0.00026) and tilt groups (p = 0.00297), along with the orbital plane angles (FOA, p = 0.020498; tilt, p = 0.07371), the anterior advancement (FOA, p = 0.00932; tilt, p = 0.05823), and the interzygomaticofrontal suture distance (FOA, p = 0.001241; tilt, p = 0.07811).ConclusionsBoth techniques improve frontoorbital dimensions for correction of metopic synostosis. In severe trigonocephaly phenotypes, the FOA allows a greater magnitude of expansion and overcorrection, but compromises preservation of a vascularized leash. The “tilt” procedure possesses the benefit of near-anatomic bandeau remodeling, while potentially improving long-term growth.     

Skeletal relapse after mandibular advancement and setback in single-jaw surgery

PURPOSE: The aim of this study was to identify contributing factors to skeletal relapse by analyzing cephalometric changes after bilateral sagittal split ramus osteotomy. PATIENTS AND METHODS: This study included 60 consecutive patients who underwent either mandibular advancement (30 patients) or setback surgery (30 patients). There were 36 women and 24 men (mean age, 23 years). The radiographs of these patients taken immediately before operation, at 1 week, and 14 months postoperatively were studied. To analyze the influence of hyper- and hypodivergent facial patterns on the surgical outcome, the patients were divided into 3 groups according to the mandibulo-nasal plane angle. The position of the maxilla was also taken into account. RESULTS: Measured at B-point, skeletal relapse was 1.3 mm (30%) after mean advancement of 4.4 mm and 0.8 mm (12%) after setback of 6.0 mm. The magnitude of the surgical movement correlated with skeletal relapse. However, the correlation was not linear. Advancement of greater than 7 mm is associated with an increased tendency to relapse (r=0.52), but setback of more than 12 mm with a decreased tendency (r=-0.95). The retrognathic patients with a high mandibulo-nasal plane angle (hyperdivergence) had 30% higher relapse rate. Patients with hypodivergent facial patterns had less relapse in both advancement and setback surgery. CONCLUSION: Skeletal relapse was affected by magnitude of surgical movement and different facial patterns according to the mandibulo-nasal plane angle; however, influences of both factors were different between mandibular advancement and setback.     

Long-term incidence of sensory disturbance in the forehead after fronto-orbital advancement in isolated nonsyndromic craniosynostosis

In the majority of the craniofacial literature, preservation of the supraorbital nerve during fronto-orbital advancement (FOA) is recommended. However, only a few studies have evaluated the incidence of sensory disturbance in the forehead after FOA during long-term follow-up.57 children who underwent FOA in their first year of life because of isolated nonsyndromic craniosynostosis including trigonocephaly, anterior plagiocephaly or oxycephaly, were evaluated for sensory disturbance in the frontal region with a minimum follow-up of 27 months.An objective and repeatable measurement using the Semmes–Weinstein test was possible in 36 children older than 5 years at last follow-up. We revealed no sensory deficits in all patients, even in 3 patients, where one of the supraorbital nerves was transected during FOA.As previous reports have suggested a full recovery of sensation after transection of the supraorbital nerve during FOA I seen, the need to preserve the nerve has to be evaluated. However, as release of the nerve from the supraorbital rim is possible, we generally recommend preserving this structure, to minimize the risk of sensory deficits in the forehead region.     

Long-term results in nonsyndromatic unilateral coronal synostosis treated with fronto-orbital advancement

Children with unilateral isolated coronal suture synostosis suffer from frontal plagiocephaly. In this retrospective study we analyzed 21 patients who were treated with an identical and standardized surgical technique of fronto-orbital advancement with hypercorrection with an average follow-up of 57.5 months.The median age at surgery was 12.1 months. The median average amount of blood loss during the operation was less than 188 ml. Not a single major complication was observed. According to the classification of Whitaker, 15 patients had a Class 1 outcome, with excellent surgical results. Three patients were defined as Class 2 outcome. One of our patients was Class 3 and two patients were Class 4 because of severe forehead retrusion and temporal hollowing. Re-operation rate was 14.3%.67% of our patients showed a correction or an improvement of the typical C-shaped deformity in their follow-up examination. Aesthetic outcomes were excellent in 13, good in 5, and poor in 3 of cases, as judged by their families and the craniofacial team.Unilateral coronal synostosis can be successfully treated by fronto-orbital advancement with a low complication rate and an excellent clinical outcome. To minimize the need of re-operations, fronto-orbital advancement should be performed with an overcorrection on the affected side.     

The skeletal stability of one-piece Le Fort 1 osteotomy to advance the maxilla; Part 1. Stability resulting from non-bone grafted rigid fixation

During the past decade, we have increasingly preferred to do a one-piece Le Fort 1 osteotomy to advance the maxilla, sometimes in isolation to treat patients with maxillary retrusive skeletal Class III patients or combined with mandibular advancement to treat bimaxillary retrusive skeletal Class II. Clinical impressions of rigid fixation techniques have indicated that there is improved stability when compared with wire fixation. There are few studies in the literature that have addressed relapse following one-piece Le Fort 1 osteotomy to advance the maxilla. Such surgery involves one single spatial movement and thereby eliminates other possible surgical variables, which may impact on the degree of stability achievable postoperatively. We studied 45 patients who had undergone a uniform one-piece maxillary advancement with elimination of controllable variables, apart from 15 patients who had simultaneous mandibular advancement. Rigid fixation was adopted throughout the study. The mean surgical change documented was 7.42 mm. The mean stability calculated at 12 months revealed a relapse of 0.72 mm (10%). This was not significant (P = 0.3). We conclude that the Le Fort 1 advancement osteotomy is a stable and surgically predictable procedure that gives only slight relapse at 12 months.     

Short- and long-term skeletal relapse after mandibular advancement surgery

This study analyzes short- and long-term skeletal relapse after mandibular advancement surgery and determines its contributing factors. Thirty-two consecutive patients were treated for skeletal Class II malocclusion during the period between 1986 and 1989. They all had combined orthodontic and surgical treatment with BSSO and rigid fixation excluding other surgery. Of these, 15 patients (47%) were available for a long-term cephalography in 2000. The measurement was performed based on the serial cephalograms taken preoperatively; 1 week, 6 months and 14 months postoperatively; and at the final evaluation after an average of 12 years. Mean mandibular advancement was 4.1 mm at B-point and 4.9 mm at pogonion. Representing surgical mandibular ramus displacement, gonion moved downwards 2 mm immediately after surgery. During the short-term postoperative period, mandibular corpus length decreased only 0.5 mm, indicating that there was no osteotomy slippage. After the first year of observation, skeletal relapse was 1.3 mm at B-point and pogonion. The relapse continued, reaching a total of 2.3 mm after 12 years, corresponding to 50% of the mandibular advancement. Mandibular ramus length continuously decreased 1 mm during the same observation period, indicating progressive condylar resorption. No significant relationship between the amount of initial surgical advancement and skeletal relapse was found. Preoperative high mandibulo-nasal plane (ML-NL) angle appears to be associated with long-term skeletal relapse.     

Cranial vault deformity and intracranial hypertension secondary to cephalic molding at delivery: a case and its management.

Cephalic molding at birth has been traditionally felt to be benign, resulting in only a transient and self-correcting cranial deformity. However, we report a 6-month-old infant who presented with extensive cephalic molding at birth in combination with persistent brachyturricephaly from unilateral coronal synostosis and occipital deformation. Helmet therapy over a 3-month period failed despite patient compliance and numerous adjustments. Intracranial hypertension developed, as documented by multiple occipital bony erosions on computed tomographic scan and by an elevated direct intracranial pressure reading. The cranial vault asymmetry was corrected in two surgical stages: (1) occipital bar advancement, temporoparietal bone remodeling, and midline sagittal strip compression to reduce vertical height, followed in 3 months by (2) fronto-orbital advancement and remodeling.     

The stability of facial osteotomies. 4. Maxillary and mandibular (with or without chin) advancement with rigid internal fixation

The short-term (6 weeks postoperative) and long-term (12 months postoperative) horizontal skeletal stability of combined maxillary and mandibular advancement was evaluated by cephalometric analysis of 15 patients.
The mean horizontal advancement of the maxilla was 5.84 mm. Six weeks later a mean horizontal relapse of 0.03 mm (0.05%) was identified. The mean horizontal relapse at long-term follow-up was 0.59 mm (10.1%).
The mean horizontal advancement of the mandible was 12.35 mm at menton and 12.65 mm at pogonion. At 6 weeks, mean horizontal relapse, respectively at the above landmarks, was 0.11 mm and 0.21 mm (1.3%). The mean horizontal relapse at long-term follow-up was 2.19 mm and 1.98 mm (16.6%) respectively for the same landmarks.
Subjectively and objectively, improvements were seen in facial aesthetics and dental occlusion. The results indicate that rigid fixation of osteotomies undertaken to correct 'horizontal facial deficiency' is a surgically predictable and relatively stable procedure when reviewed up to 12 months after surgery.     

颅缝早闭额眶后缩畸形的早期手术治疗

目的 探讨颅缝早闭引起的额眶后缩畸形早期手术治疗的方法.方法 本组共10例额眶后缩患者,年龄6～9个月.非综合征性颅缝早闭8例,其中额缝早闭2例、单侧冠状缝早闭3例、双侧冠状缝早闭3例;综合征性冠状缝早闭2例,分别为阿佩尔综合征(Apert syndrome)和克鲁宗综合征(Crouzon syndrome)各1例.采取双侧额顶部开颅,眶周"C"型截骨、前移以及额骨放射状骨切开塑形的方法纠正额眶后缩畸形.结果 手术后额眶后缩畸形明显改善,外形良好,无严重并发症.8例术后随访3～11个月,颅面部外形维持良好,额眶后缩畸形无复发.结论 额骨、眶周联合截骨塑形前移的方法能够有效地矫正颅缝早闭所致额眶后缩畸形.     

A 3-year evaluation of skeletal stability of mandibular advancement with rigid fixation

The postsurgical changes associated with mandibular advancements using the sagittal ramus osteotomy and rigid fixation were evaluated. This retrospective study was based on examination of lateral cephalometric radiographs of 19 individuals (16 females and 3 males) with a mean age of 26.6 years. These radiographs were evaluated presurgically, immediately postsurgery, and 3 years postsurgically (2 years, 9 months to 4 years, 5 months). The mean amount of sagittal surgical advancement was 6.7 +/- 2.3 mm, and the mean amount of postsurgical relapse was 1.3 +/- 2.0 mm, representing a 14% relapse of the original surgical advancement. However, individual variation in the amount and direction of movement of the mandible was found during the follow-up period. Postsurgical relapse was found to be related to the amount of surgical advancement. Linear-regression analysis between these two variables resulted in an R2 value of 0.448. Fourteen of the subjects relapsed in the posterior direction, with 2 relapsing more than 50% of the surgical advancement. Five of the subjects moved further anteriorly, with 1 advancing as much as 50% more than the original advancement. The findings of this study suggest that mandibular advancement with the sagittal ramus osteotomy and rigid fixation does not provide consistently stable postsurgical results. However, when compared with previously reported relapse studies using nonrigid fixation techniques, rigid fixation yielded superior results.     

Cranial vault growth patterns of plagiocephaly and trigonocephaly patients following fronto-orbital advancement: A long-term anthropometric outcome assessment

Fronto-orbital advancement (FOA) is the most common technique used to correct plagiocephaly and trigonocephaly. The aim of this study was to investigate the cranial vault growth following FOA and to compare the growth pattern to the normal standard. Fifty-two Swiss children (25 with anterior plagiocephaly and 27 with trigonocephaly) between the surgical ages of 8 and 10 months were included in this 5-year follow-up study. A standardised time protocol (before the procedure; 6 weeks and 6 months after the surgery; and then annually until the age of six) for anthropometric skull measurements (head circumference, cranial length, and breadth and cephalic indices) was used to analyse the pre- and post-operative cranial vault growth patterns. Data were converted into the Z-score for standardised inter-centre comparison. For all the patients, a significant improvement in the shape of the cranial vault following FOA was observed. In both the plagiocephaly and trigonocephaly groups, the long-term cranial growth patterns (head circumference and cranial length and breadth) significantly differed following this procedure in comparison to those of the control group. The cephalic indices remained constant; no significant changes were found in either study population. Fronto-orbital advancement in anterior craniosynostotic patients between the ages of 8 and 10 months seems to be ideal, as the procedure promotes solid cranial vault growth, ensuring positive surgical results.     

Temporomandibular joint bony ankylosis: comparison of treatment with transport distraction osteogenesis or the matthews device arthroplasty

Temporomandibular joint (TMJ) bony ankylosis with micrognathia is a rare congenital condition that is difficult to treat and may result in recurrence. In a series of affected patients, we compared two new methods of treatment: transport distraction osteogenesis and Matthews Device arthroplasty. All patients had computed tomography scan documented bilateral TMJ bony ankylosis. Group I (transport distraction osteogenesis) underwent distraction advancement of the mandible (for micrognathia) followed by resection of the condyles, recontouring of the glenoid fossas with interposition temporoparietal-fascial flaps, and transport distraction osteogenesis of mandibular rami segments. Group II (Matthews Device arthroplasty) underwent all of the above procedures except for transport distraction osteogenesis. Instead, the Matthews Devices were anchored to the temporal bone and mandibular rami. Hinged arms allowed for motion at the reconstructed TMJ. In both groups, patients underwent extensive postoperative therapy. Preoperative, postoperative, and follow-up lateral cephalograms were obtained, and incisor opening distances were recorded. All patients but one had severe micrognathia (n = 9). For group I (transport distraction osteogenesis), mean age was 6.8 years. and mean advancement was 28.5 mm. For group II (Matthews Device arthroplasty) mean age was 8.2 years, and mean advancement was 23.5 mm. In group I (transport distraction osteogenesis), mean incisor opening was 1 mm preoperatively and 27.5 mm postoperatively; however, it relapsed to 14.3 mm by 12.5 months follow-up (48% relapse). Mean incisor opening in group II (Matthews Device arthroplasty) was 3.9 mm preoperatively and 33.4 mm postoperatively and remained at 30.6 mm after 11.1 months follow-up (8% relapse). One patient in group I (transport distraction osteogenesis) underwent surgical revision because of relapse. Our data showed that for congenital TMJ bony ankylosis both transport distraction osteogenesis and Matthews Device arthroplasty techniques were successful initially; however, the Matthews Device arthroplasty avoided long-term relapse.     

Stability of skeletal Class III malocclusion after combined maxillary and mandibular procedures

The aim of this study was to evaluate the skeletal stability and time course of postoperative changes after surgical correction of skeletal Class III malocclusion. Combined maxillary and mandibular procedures were performed in 40 consecutive patients. Bilateral sagittal split osteotomy stabilized with wire osteosynthesis for mandibular setback and low-level Le Fort I osteotomy stabilized with plates and screws for maxillary advancement were performed. Maxillomandibular fixation (MMF) was in place for 6 weeks. Lateral cephalograms were taken before surgery, immediately postoperatively, 8 weeks after surgery, and 1 year postoperatively. Patients were divided into 2 groups according to vertical maxillary movement at surgery: a maxilla-up group with upward movement of the posterior nasal spine of 2 mm or more (group 1, n = 22), and a minimal vertical change group with less than 2 mm of vertical repositioning (group 2, n = 18). The results indicate that surgical correction of Class III malocclusion with combined maxillary and mandibular osteotomies appears to be fairly stable. One year postsurgery, maxillary stability was excellent, with a mean horizontal relapse at point A that represented 10.7% of maxillary advancement in group 1 and 13.4% in group 2. In the vertical plane, maxillary stability was also excellent, with a mean of 0.18 mm of superior repositioning at point A for group 1 and 1.19 mm for group 2. The mandible relapsed a mean of 2.97 mm horizontally at pogonion in group 1 (62% of mandibular setback) and 3.41 mm (49.7% of setback) in group 2. Bilateral sagittal split osteotomy with wire osteosynthesis and MMF was not as stable as maxillary advancement and accounted for most of the total horizontal relapse (almost 85%) observed. A trend to relapse was observed for maxillary advancement greater than 6 mm, while the single variable accounting for mandibular relapse in group 1 was the amount of surgical setback. Clockwise rotation of the ascending ramus at surgery was not correlated with mandibular relapse in relation to the type of fixation performed and therefore does not seem to be responsible for relapse.     

正颌外科手术矫正唇腭裂继发颌骨畸形术后上颌稳定性的研究

目的 探讨正颌外科手术矫正唇腭裂继发颌骨畸形患者术后上颌骨的稳定性及相关影响因素.方法 34例唇腭裂继发上颌骨发育不足的患者,均行改良LeFortⅠ型截骨术前徙上颌骨,其中29例患者同期行BSSRO和/或颏成形术,术后随访时间≥12月.分别在术前、术后即刻及术后随访时拍摄头颅定位侧位片.通过头影测量分析,测量上齿槽座（A）点、后鼻嵴（PNS）点、∠SNA的变化.结果 34例患者术后1年以上（平均19个月）水平向复发率为（20.10±18.09）％;垂直向复发率为（34.78±32.89）％.∠SNA术前平均为77.9°,术后即刻为82.3°,术后1年以上为81.4°.水平向复发率与上颌骨前徙量无相关性（P＞0.05）,但垂直向的复发率与上颌骨下移量呈正相关性（P＜0.05）.通过对15例连续随访患者资料的方差分析提示,上颌骨术后复发主要发生在术后3个月内.结论 唇腭裂患者上颌骨前徙术后具有一定程度的复发,其复发主要发生在术后3个月内.垂直向的复发率与颌骨下移量成正相关.     

Mandibular advancement using a retrocondylar cartilage graft: a 20-year prospective study

We examined the outcome after a mean of 46 months (range 18-204) of 73 patients with severe mandibular retrusion who had surgical advancement of the mandible by a post-condylar cartilage graft. The extent of the mandibular advance and the change in position of the condyle were measured by a previously described cephalometric method. Tomograms of the temporomandibular joint (TMJ) were taken at defined intervals and any changes in the articulation recorded. The mandible was advanced by a mean (S.D.) of 9.8 (3.4) mm. The mean postoperative change recorded on the final cephalometric radiograph was 0.4 (4.7) mm forward (95% CI -0.70 to+1.50). The mandibular condyle was advanced horizontally by a mean 7.2 (2.1) mm and depressed vertically by a mean of 5.9 (2.6) mm. postoperatively the condyle relapsed horizontally by a mean of 1.5mm and moved vertically downward by a mean of 0.2mm. Eleven patients had substantial skeletal relapse. Eight patients were regarded as clinical failures. Skeletal relapse did not always lead to clinical failure because of compensatory mandibular growth. Changes in the condylar region, which contributed to relapse, included condylar absorption and remodelling (n=7) and absorption of the cartilage graft (n=6). There were no postoperative functional problems with the TMJ. We conclude that the post-condylar cartilage graft is a useful technique for the treatment of certain cases of mandibular retrusion. The postoperative morbidity was less than that reported after other techniques of mandibular advancement including distraction. Skeletal relapse was found in more cases than clinical results had suggested.     

Onlay bone graft augmentation for refined correction of coronal synostosis.

OBJECTIVE: The primary purpose of this study was to evaluate the long-term result of an onlay bone graft augmentation of the supraorbital ridge at the time of primary correction of coronal suture synostosis. DESIGN: The study is a retrospective review of 62 consecutive patients treated for coronal synostosis from June 1991 through February 1997. The surgical technique utilized involved a standard bilateral fronto-orbital advancement and calvarial reshaping with the addition of an onlay bone graft in the supraorbital region. SETTING: All patients were treated at a tertiary care craniofacial center. RESULTS AND CONCLUSION: A total of 62 patients were treated by this technique. Fifty patients underwent primary correction as infants (mean age 9.8 months). An additional 12 patients were older (mean age 8.2 years) and were treated for residual deformity having previously undergone correction by another technique. Results with follow-up as long as 7 years demonstrate stable forehead and orbital symmetry. Complications identified by chart review were minimal and not directly attributable to this modification in surgical technique.     

Stability of the hard and soft tissue profile after mandibular advancement in sagittal split osteotomies: a longitudinal and long-term follow-up study

The aim of the study was to conduct a long-term follow-up investigation of the stability of hard and soft tissues after bilateral sagittal split osteotomy (BSSO) with rigid internal (RIF) fixation to advance the mandible. Sixteen consecutive patients (12 females and 4 males, mean age 21.4 years) were available for re-examination 12.7 years (T5) after surgery. The preceding follow-ups were before (T1), and 5 days (T2), 7.3 months (T3), and 13.9 months (T4) after surgery. Lateral cephalograms were traced by hand, digitized, and evaluated with the Dentofacial Planner program. The x-axis for the system of co-ordinates ran through sella (point zero) and the line NSL -7 degrees. Thus, the program determined the x- and y-values of each variable and the usual angles and distances. Statistical analysis was carried out using Wilcoxon's matched-pair signed-ranks test with Bonferroni adjustments. The relationships between the examined variables were analysed by Spearman rank correlation coefficients. The backward relapse at point B (T5) was 2.42 mm, or 50 per cent, and at pogonion 3.21 mm, or 60 per cent of the initial advancement. The mean net effect at T5 on the labial fold (soft tissue point B) was 94 per cent of the advancement at point B. For the soft tissue chin (soft tissue pogonion), it was 119 per cent of the advancement at pogonion. The net effect on the lower lip (labrale inferior) was 55 per cent of the advancement at incision inferior. The amount of the surgical advancement of the mandible was correlated with the long-term relapse in point B. Among possible reasons for this relapse are the initial soft tissue profile, the initial growth direction, and the remodelling processes of the hard tissue.     

Long-term hard and soft tissue relapse rate after genioplasty

PURPOSE: The purpose of this study was to assess hard and soft tissue stability 12 months after advancement genioplasty. MATERIAL AND METHODS: This is a retrospective study of 20 patients who underwent either advancement genioplasty alone (n = 11) or in combination with bilateral sagittal split osteotomy for mandibular advancement (n = 9). Lateral cephalometric radiographs were traced and immediate postoperative changes and 12-month postoperative changes were defined. The relapse rate for the pogonion, the soft tissue pogonion, and the soft tissue B point (Bs) were evaluated. The results were compared for combined mandibular advancement plus genioplasty versus genioplasty alone. Relapse rates were also correlated with the amount of advancement. All patients were treated with rigid internal fixation. RESULTS: After 12 months, the pogonion, the soft tissue pogonion, and the soft tissue B point had a mean relapse rate of -0.38 mm, -1.2 mm, and -1.5 mm (negative value indicates a relapse, and a positive value indicates prolapse), respectively, which was not significant at probability values of.45,.069, and.054, respectively. Relapse was not statistically related to the amount of advancement. There was no significant difference between the relapse rate for genioplasty alone versus combined bilateral sagittal split osteotomy and genioplasty, even with different amounts of advancement. CONCLUSIONS: Advancement genioplasty is an important and reliable technique for the esthetic treatment of the lower facial skeleton. The results indicate that there is no significant relapse after genioplasty and bilateral sagittal split osteotomy or genioplasty alone after 12 months when rigid internal fixation is used. The changes were minimal and hard to detect clinically. Genioplasty, with or without mandibular advancement, is a stable surgical procedure when used in conjunction with rigid internal fixation.     

Application of the spanning plate concept to frontal orbital advancement: techniques and clinical experience in 60 patients

Frontal orbital advancement (FOA), is the procedure of choice in treatment of coronal and metopic synostosis. Resorbable plates and screws have been widely accepted for use in pediatric craniofacial surgery, including FOA. We have applied the concept of extended resorbable spanning plates to FOA for metopic, unilateral, and bilateral coronal synostosis in infants and children during a 5-year period. We report on 60 patients, ages 4 to 15 months (mean, 7 months); 28 girls, 32 boys. Follow-up ranged from 12 to 36 months (mean, 24 months). There were no structural failures, no infections, and no complications related to the use of extended spanning plates. Extended spanning plates decrease mobility between bone segments, confer greater stability to the construct, and reduce both the number of plates and of screws that are necessary and reduce the operative time. Application of these plates simplifies FOA surgery and represents a step in the evolution of plating technology.     

Trigonocephaly: Results after surgical correction of nonsyndromatic isolated metopic suture synostosis in 54 cases

Children with nonsyndromatic isolated metopic suture synostosis suffer from a significant deformity of the supraorbital ridges, the temporal regions and hypotelorism. We retrospectively analyzed 54 consecutive cases of isolated nonsyndromatic metopic synostosis treated over a 14-year-period. The data were evaluated using patients’ clinical records, skull radiographs in two planes, CT-scans, MRI scans and pre-/post-operative photographs. Surgery with standardized fronto-orbital advancement was performed at a median age of 11.5 months. Follow-up ranged from 4.5 months to 177.4 months, with an average of 51.9 months. The average blood loss was less than 255 ml and the average post-operative length of stay was 5 days. Not a single major complication was observed except for uncomplicated dural tears in six cases. According to the classification of Whitaker, results were considered good to excellent (Category I and II) in all except one case (Category IV). As the current techniques have been standardized for routine use, surgical risks are reasonably low with no mortality or permanent morbidity. We think that the treatment of single metopic synostosis is safe with very low reoperation rates and short length of hospital stay. Overall, our results showed acceptable minor complication rates and generally satisfactory aesthetic outcomes.