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The cranial orbital buttress technique for nonsyndromic unicoronal and metopic craniosynostosis.
Neurosurg Focus. 2015 May; 38(5):E4.NF

Abstract

OBJECT Current craniosynostosis procedures can result in complications due to absorbable plates and screws or other specialized expensive hardware. The authors propose the cranial orbital buttress (COB) technique of frontoorbital remodeling for metopic and unicoronal synostoses, wherein no plates or screws are used. They hypothesize that, with this technique, aesthetically acceptable outcomes for unicoronal and metopic synostosis can be achieved. In this article, they present this technique and compare the results with current frontoorbital remodeling practices. METHODS The authors conducted a retrospective chart review of cases in which patients with nonsyndromic unicoronal or metopic synostosis underwent cranio-orbital surgery at their institution from 1985 through 2009. Operative parameters, surgical variations, and complications were analyzed. The COB technique uses a 1-piece switch, hemiforeheads, or multiple pieces for forehead remodeling. The supraorbital bar is reconstructed in patients with metopic synostosis using a double wedge or greenstick fracture technique, and in patients with unicoronal synostosis a hinge procedure based on a 1.5-orbital osteotomy is used. The supraorbital bar is advanced and supported in place by bone graft(s) inserted at the lateral aspect(s) of the orbit(s) to form a buttress, with fixation done using absorbable sutures. RESULTS A total of 79 cases met the criteria for inclusion in the study. Twenty-nine patients had metopic synostosis, 3 had combined metopic and sagittal synostoses, and 47 had unicoronal synostosis. The patients' mean age at surgery was 11.4 ± 10.1 months and the mean operative time was 183.4 ± 41.0 minutes. The mean length of hospital stay was 3.7 ± 1.2 days. The mean blood loss was 150.0 ± 125.6 ml, and 33% of patients required a blood transfusion (mean volume 206.9 ± 102.3 ml). In metopic synostosis, hemiforeheads were used most often (24/29, 83%), and the supraorbital bar was remodeled using a bilateral intracranial orbital osteotomy followed by a double wedge modification (23/29, 79%) or a greenstick fracture (4/29 14%) for milder cases. Forehead remodeling for unicoronal synostosis was by a forehead switch (39/47, 83%) and the supraorbital bar was remodeled using a 1.5-orbital intracranial orbital osteotomy (34/47, 72%) such that the bar was advanced on the abnormal side and hinged at the midline of the normal orbit. Perioperative complications occurred in 19% of cases and included dural tears (16%), inconsequential subdural hematoma (1.3%), and nasal greenstick fracture (1.3%). The total reoperation rate was 7.6% (cranioplasties for irregular contours, 6.3%; scar revision, 1.3%). CONCLUSIONS The COB remodeling technique is simple and efficient, gives acceptable outcomes, and is less resource intensive than previous techniques reported in the literature.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Seal SK
Divisions of 1 Plastic Surgery and.
Steinbok P
No affiliation info available
Courtemanche DJ
No affiliation info available

MeSH

CraniosynostosesCraniotomyFemaleHumansInfantLength of StayMaleOrbitPlastic Surgery ProceduresRetrospective Studies

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25929966

Citation

Seal, Shane K F., et al. "The Cranial Orbital Buttress Technique for Nonsyndromic Unicoronal and Metopic Craniosynostosis." Neurosurgical Focus, vol. 38, no. 5, 2015, pp. E4.
Seal SK, Steinbok P, Courtemanche DJ. The cranial orbital buttress technique for nonsyndromic unicoronal and metopic craniosynostosis. Neurosurg Focus. 2015;38(5):E4.
Seal, S. K., Steinbok, P., & Courtemanche, D. J. (2015). The cranial orbital buttress technique for nonsyndromic unicoronal and metopic craniosynostosis. Neurosurgical Focus, 38(5), E4. https://doi.org/10.3171/2015.2.FOCUS14844
Seal SK, Steinbok P, Courtemanche DJ. The Cranial Orbital Buttress Technique for Nonsyndromic Unicoronal and Metopic Craniosynostosis. Neurosurg Focus. 2015;38(5):E4. PubMed PMID: 25929966.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The cranial orbital buttress technique for nonsyndromic unicoronal and metopic craniosynostosis. AU - Seal,Shane K F, AU - Steinbok,Paul, AU - Courtemanche,Douglas J, PY - 2015/5/2/entrez PY - 2015/5/2/pubmed PY - 2016/2/13/medline KW - COB = cranial orbital buttress KW - bone graft KW - craniosynostosis KW - frontal plagiocephaly KW - metopic synostosis KW - operative technique KW - trigonocephaly KW - unicoronal synostosis SP - E4 EP - E4 JF - Neurosurgical focus JO - Neurosurg Focus VL - 38 IS - 5 N2 - OBJECT Current craniosynostosis procedures can result in complications due to absorbable plates and screws or other specialized expensive hardware. The authors propose the cranial orbital buttress (COB) technique of frontoorbital remodeling for metopic and unicoronal synostoses, wherein no plates or screws are used. They hypothesize that, with this technique, aesthetically acceptable outcomes for unicoronal and metopic synostosis can be achieved. In this article, they present this technique and compare the results with current frontoorbital remodeling practices. METHODS The authors conducted a retrospective chart review of cases in which patients with nonsyndromic unicoronal or metopic synostosis underwent cranio-orbital surgery at their institution from 1985 through 2009. Operative parameters, surgical variations, and complications were analyzed. The COB technique uses a 1-piece switch, hemiforeheads, or multiple pieces for forehead remodeling. The supraorbital bar is reconstructed in patients with metopic synostosis using a double wedge or greenstick fracture technique, and in patients with unicoronal synostosis a hinge procedure based on a 1.5-orbital osteotomy is used. The supraorbital bar is advanced and supported in place by bone graft(s) inserted at the lateral aspect(s) of the orbit(s) to form a buttress, with fixation done using absorbable sutures. RESULTS A total of 79 cases met the criteria for inclusion in the study. Twenty-nine patients had metopic synostosis, 3 had combined metopic and sagittal synostoses, and 47 had unicoronal synostosis. The patients' mean age at surgery was 11.4 ± 10.1 months and the mean operative time was 183.4 ± 41.0 minutes. The mean length of hospital stay was 3.7 ± 1.2 days. The mean blood loss was 150.0 ± 125.6 ml, and 33% of patients required a blood transfusion (mean volume 206.9 ± 102.3 ml). In metopic synostosis, hemiforeheads were used most often (24/29, 83%), and the supraorbital bar was remodeled using a bilateral intracranial orbital osteotomy followed by a double wedge modification (23/29, 79%) or a greenstick fracture (4/29 14%) for milder cases. Forehead remodeling for unicoronal synostosis was by a forehead switch (39/47, 83%) and the supraorbital bar was remodeled using a 1.5-orbital intracranial orbital osteotomy (34/47, 72%) such that the bar was advanced on the abnormal side and hinged at the midline of the normal orbit. Perioperative complications occurred in 19% of cases and included dural tears (16%), inconsequential subdural hematoma (1.3%), and nasal greenstick fracture (1.3%). The total reoperation rate was 7.6% (cranioplasties for irregular contours, 6.3%; scar revision, 1.3%). CONCLUSIONS The COB remodeling technique is simple and efficient, gives acceptable outcomes, and is less resource intensive than previous techniques reported in the literature. SN - 1092-0684 UR - https://www.unboundmedicine.com/medline/citation/25929966/The_cranial_orbital_buttress_technique_for_nonsyndromic_unicoronal_and_metopic_craniosynostosis_ DB - PRIME DP - Unbound Medicine ER -