Anthropometric Outcomes following Fronto-Orbital Advancement for Metopic Synostosis

Abstract

Background The authors’ purpose is to present changes in anthropometric fronto-orbital dimensions after surgical correction of metopic synostosis. Methods The authors retrospectively analyzed craniometric dimensions in older patients with metopic synostosis corrected by fronto-orbital advancement performed by the senior author (J.B.M.). Preoperative and postoperative linear measures (frontal breadth, cranial width, and intercanthal distance) were taken by direct anthropometry. Interdacryon distance and width of the bandeau were also recorded intraoperatively, before and after widening. Follow-up anthropometric values were compared to age- and sex-matched normative data and standard (z) scores were calculated. Results Sixteen patients met the inclusion criteria. Syndromic diagnosis was documented in five of 16 patients. Average age at the last postoperative evaluation was 8.9 ± 3.8 years (range, 4 to 16 years). Mean frontal width z-scores decreased postoperatively from 0.82 to –0.32 (p = 0.007), indicating diminished growth in this dimension. The last measured frontal width strongly correlated with the breadth of the bandeau after surgical correction but not with preoperative values. Postoperative mean cranial width diminished significantly to a more normal value. Mean intercanthal distance was normal preoperatively and remained so but was significantly greater in syndromic than in nonsyndromic cases. Conclusions Frontal growth rate is diminished in the coronal plane after fronto-orbital advancement. The authors recommend primary techniques to overcorrect the width of the bandeau and frontal region, including zygomaticosphenoid osteotomies and interpositional cranial bone grafts to advance/widen the lateral orbital rim. Continued evaluation is required to assess whether overcorrection results in normal frontotemporal shape and breadth at skeletal maturity.

School-Aged Anthropometric Outcomes After Endoscopic or Open Repair of Metopic Synostosis

“…These techniques are similar to those described by other high-volume craniofacial centers. [5][6][7][8]12,13…”

“…These observations have led multiple groups to advocate for overcorrection of the deformity at time of initial operation. 12,13 At our institution, we employ a combination of barrel-stave osteotomies, interpositional bone grafts, and/or temporalis muscle flaps to overcorrect frontal width to that of a 6-year-old child. 13 Our techniques are similar to those described by other high-volume centers.…”

“…Traditionally, metopic synostosis has been treated by open cranial vault expansion with fronto-orbital advancement when the infant reaches 6 to 12 months of age. [5][6][7][8][9][10][11][12][13] Recently, minimally invasive endoscopic strip craniectomy with postoperative helmet therapy has gained favor; however, only young infants ,6 months of age (ideally 2-4 months) are suitable candidates because it relies on early rapid brain growth to achieve normocephaly. 14,15 Current evidence has revealed that anthropometric outcomes after endoscopic and open repairs of metopic synostosis are equivalent at 1-year postoperative.…”

Cost comparison of surgical management of nonsagittal synostosis: traditional open versus endoscope-assisted techniques

“…Open CVR is performed using standard FOA techniques for metopic or unicoronal synostosis, and patients with lambdoid synostosis are treated with posterior CVR. 25,30,34 For open CVR, we use a resorbable plating system (SonicWeld, KLS Martin).…”

Surgical Correction of Metopic Craniosynostosis: A 3-D Photogrammetric Analysis of Cranial Vault Outcomes

“…Other limitations of our study include the sample size and duration of follow-up, as outcomes can vary and show recurrence in 5 to 10 years postoperatively. Longer term studies have demonstrated a trend of temporal hollowing, some of which may be attributed to soft tissue atrophy as well as bone reshaping over time (Fearon et al, 2009; Steinbacher et al, 2011; Seruya et al, 2014; Wes et al, 2014; Patel et al, 2016). We may also not be fully capturing the deformity as we analyzed the contours in a single axial plane 20 mm above the glabella.…”