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Three-Dimensional Reconstruction of Orbital Fractures

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The shell technique: bilateral fronto-orbital reshaping in trigonocephaly.

Concezio Di Rocco¹, Paolo Frassanito, Gianpiero Tamburrini

¹Pediatric Neurosurgery, Catholic University Medical School, Largo Agostino Gemelli, 8, 00168, Rome, Italy.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery

|August 24, 2012

Summary

The shell technique effectively corrects trigonocephaly in infants, reducing surgery time and blood loss. This method provides excellent aesthetic and functional outcomes for premature fusion of the skull.

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Area of Science:

Pediatric Neurosurgery
Craniofacial Surgery
Developmental Biology

Background:

Trigonocephaly, a premature fusion of the metopic suture, requires surgical correction for proper brain development and skull shape.
Traditional cranial vault reshaping procedures can be lengthy and involve significant blood loss.

Purpose of the Study:

To evaluate the efficacy and outcomes of the shell technique for trigonocephaly correction.
To compare the shell technique with other surgical methods regarding surgical time, blood loss, and results.

Main Methods:

The shell technique involves multiple radial osteotomies to remodel the bifrontal bone without creating a supraorbital bar.
Supraorbital ridges are modified in situ, minimizing operative blood loss.
The procedure is best performed between 3 and 9 months of age when skull bones are more ductile.

Main Results:

The shell technique significantly reduces surgical time and intraoperative blood loss compared to other procedures.
It achieves aesthetic and functional results comparable to more extensive cranial vault reshaping.
Optimal results are achieved in infants aged 3-9 months due to bone plasticity and enhanced regeneration.

Conclusions:

The shell technique is a safe and effective method for correcting trigonocephaly in infants.
It offers advantages in reduced surgical morbidity and comparable outcomes to more invasive procedures.
Potential residual deformities like hypotelorism or temporal depression may relate to the extent of cranial base involvement rather than the technique itself.