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.
Keywords: Fronto-orbital advancement; Metopic; Metopic synostosis; Suture; Tilt procedure; Trigonocephaly.
Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.