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Comparing two fronto-orbital advancement strategies to treat trigonocephaly in metopic synostosis.
J Craniomaxillofac Surg. 2014 Oct; 42(7):1437-41.JC

Abstract

BACKGROUND

Trigonocephalic 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.

METHODS

Demographic 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.

RESULTS

40 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).

CONCLUSIONS

Both 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.

Authors+Show Affiliations

Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar St, BB 3rd Floor, New Haven, CT 06520, USA.Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar St, BB 3rd Floor, New Haven, CT 06520, USA.Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar St, BB 3rd Floor, New Haven, CT 06520, USA.Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar St, BB 3rd Floor, New Haven, CT 06520, USA. Electronic address: derek.steinbacher@gmail.com.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

24997751

Citation

Metzler, Philipp, et al. "Comparing Two Fronto-orbital Advancement Strategies to Treat Trigonocephaly in Metopic Synostosis." Journal of Cranio-maxillo-facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery, vol. 42, no. 7, 2014, pp. 1437-41.
Metzler P, Ezaldein HH, Persing JA, et al. Comparing two fronto-orbital advancement strategies to treat trigonocephaly in metopic synostosis. J Craniomaxillofac Surg. 2014;42(7):1437-41.
Metzler, P., Ezaldein, H. H., Persing, J. A., & Steinbacher, D. M. (2014). Comparing two fronto-orbital advancement strategies to treat trigonocephaly in metopic synostosis. Journal of Cranio-maxillo-facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery, 42(7), 1437-41. https://doi.org/10.1016/j.jcms.2014.04.006
Metzler P, et al. Comparing Two Fronto-orbital Advancement Strategies to Treat Trigonocephaly in Metopic Synostosis. J Craniomaxillofac Surg. 2014;42(7):1437-41. PubMed PMID: 24997751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparing two fronto-orbital advancement strategies to treat trigonocephaly in metopic synostosis. AU - Metzler,Philipp, AU - Ezaldein,Harib H, AU - Persing,John A, AU - Steinbacher,Derek M, Y1 - 2014/04/26/ PY - 2014/03/02/received PY - 2014/04/11/revised PY - 2014/04/15/accepted PY - 2014/7/7/entrez PY - 2014/7/7/pubmed PY - 2015/12/15/medline KW - Fronto-orbital advancement KW - Metopic KW - Metopic synostosis KW - Suture KW - Tilt procedure KW - Trigonocephaly SP - 1437 EP - 41 JF - Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery JO - J Craniomaxillofac Surg VL - 42 IS - 7 N2 - BACKGROUND: Trigonocephalic 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. METHODS: Demographic 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. RESULTS: 40 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). CONCLUSIONS: Both 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. SN - 1878-4119 UR - https://www.unboundmedicine.com/medline/citation/24997751/Comparing_two_fronto_orbital_advancement_strategies_to_treat_trigonocephaly_in_metopic_synostosis_ DB - PRIME DP - Unbound Medicine ER -