Surgical treatment of metopic synostosis

Metopic synostosis is characterized by keel-shaped forehead (trigonocephaly), prominent midline ridge of the forehead, bitemporal narrowing, bilateral retrusion of supraorbits, egg-shaped orbits, low nasal dorsum, and reduced volume of the anterior cranial fossa. The mainstay treatment is early surgical intervention before the age of 12 months, which usually consists of bifrontal craniotomy with bilateral recontouring, lateral advancement, and lateral displacement of the superior orbital rims. Here, we have developed a new simplified technique for surgical treatment of trigonocephaly. A total of 60 cases of trigonocephaly were operated on between January 1995 and January 2010 by the first author. Surgical outcomes were evaluated 6 months after surgery using postoperative photographs and clinical examination notes, and scaling was made using the Whitaker classification. The evaluation showed that 85% of them were in class I, 11.6% were in class II, and 3.3% were in class III. No case was in class IV. Only the last 10 cases received the new surgical technique, and all were in class I. Complication rate was 38.3% for all cases and was only 20% for the last 10 cases, that is, the new technique group. Revision rate for trigonocephaly surgery was 13.3%, and the most common reason was hardware removal. None of the patients from the new technique group underwent revision surgery. We believe that our new technique is fast and easy, can provide sufficient bone graft, and is more useful for older patients (>1 y). Early postoperative results have been promising.