On the origin of bitemporal hollowing

Area of Science:

• Craniofacial surgery
• Pediatric plastic surgery
• Skeletal biology

Background:

• Cranioplasty for trigonocephaly often results in long-term bitemporal hollowing and hypotelorism.
• These findings suggest persistent restriction in periorbital and forehead growth post-correction.
• The study aims to evaluate long-term periorbital growth after trigonocephaly correction.

Purpose of the Study:

• To assess the long-term growth of the periorbital region after cranioplasty for trigonocephaly.
• To investigate the relationship between postoperative deformities and growth patterns.
• To identify factors influencing long-term outcomes.

Main Methods:

• Cephalometric analysis of 33 patients with trigonocephaly undergoing cranioplasty (1972-2004).
• Radiographs and photographs taken at least 1 year postoperative and before age 6.
• Growth ratios and visual assessment of temporal hollowing were used to evaluate forehead growth and deformity.

Main Results:

• A significant correlation exists between severe postoperative temporal hollowing and lower forehead growth ratios.
• Preoperative deformity did not predict postoperative growth or deformity.
• Surgeon experience was a significant factor influencing postoperative photographic outcomes.

Conclusions:

• Bitemporal hollowing appears to be of bony origin, stemming from skeletal growth inhibition.
• Persistent deformities, if present early post-surgery, tend to endure over time.
• Surgical technique and experience are critical in mitigating long-term cosmetic deficits.