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Long-term follow-up on a case of untreated trigonocephaly
D K Ousterhout1, S J Peterson-Falzone
1Center for Craniofacial Anomalies, University of California, San Francisco 99143-0442.
Insights
Metopic synostosis (trigonocephaly) is usually surgically corrected in infants. However, this case study questions the necessity of early intervention for nonsyndromic trigonocephaly, presenting an adult with mild residual deformity.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Developmental Biology
Background:
- Trigonocephaly, a premature fusion of the metopic suture, is typically addressed surgically in infancy.
- Current surgical protocols aim for aesthetic and functional outcomes, with generally positive results in nonsyndromic cases.
- Historical observations suggest spontaneous improvement in some individuals, prompting re-evaluation of treatment necessity.
Abstract:
Trigonocephaly is typically treated during the second 3 months of life by metopic suture synostectomy, orbital rim advancement, and cranioplasty. The results are generally very pleasing in nonsyndromic patients. We have not, however, seen adults with residual deformity who preceded the present basic approach to treatment first described by Hoffman and Mohr (1976). Dominguez et al (1981) described 15 individuals who improved without treatment. The question that arises is whether we are treating this congenital problem unnecessarily, particularly in nonsyndromic patients. We present a 38-year-old untreated woman who still has residual signs of the deformity seen in early childhood photographs.