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Forehead Widening in Nonsyndromic Scaphocephaly Operated After 12 Months of Age
Giovanna Paternoster1, X L Jing2, Samer E Haber1
1Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Service de neurochirurgie pédiatrique, Unité fonctionnelle de chirurgie crânio-faciale; Filière TeteCou, Centre de Références Maladies Rares CRANIOST, Université Paris Descartes, Paris, France.
Insights
Late-presenting sagittal synostosis in children can be effectively treated with a modified forehead remodeling technique. This approach widens the forehead and improves the fronto-nasal angle, offering satisfactory aesthetic outcomes.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Plastic Surgery
Background:
- Isolated sagittal synostosis typically presents in infancy.
- Late presentation after 12 months reduces spontaneous remodeling potential.
- Standard surgical timing is around 4 months for optimal outcomes.
Purpose of the Study:
- To evaluate a modified surgical technique for late-presenting isolated sagittal synostosis.
- To assess forehead remodeling and subtotal calvarial remodeling in older children.
- To determine the efficacy of a novel technique for scaphocephalic deformities.
Main Methods:
- Retrospective study of patients over 1 year old with isolated sagittal synostosis (2011-2015).
- Inclusion criteria: surgery after 1 year, pre/postoperative CT scans.
- Data collected: age at surgery, procedure duration, surgical technique, fronto-nasal angle, forehead width.
Main Results:
- Ten patients (15 months to 6 years) were included.
- Mean age at surgery was 28 months; mean follow-up was 23 months.
- Significant improvements observed in fronto-nasal angle and forehead width.
Conclusions:
- Late-presenting scaphocephalic patients benefit from forehead remodeling.
- Modified technique involving sagittal forehead splitting and midline bone grafting is safe and feasible.
- Further long-term follow-up is necessary to fully assess the technique's efficacy.
Aim And Scope:
Our standard management is to operate isolated sagittal synostosis around 4 months of age because of morphological and cognitive outcomes. However, some patients present late and the likelihood of spontaneous remodeling is low in isolated sagittal craniosynostosis operated on after 12 months of age with a limited technique. The preliminary result of a modified technique for forehead remodeling and subtotal calvarial remodeling in nonsyndromic scaphocephalic children with late presentation is presented.
Patients And Methods:
All patients older than 1 with isolated sagittal synostosis assessed between 2011 and 2015, over 1 year of age at the time of surgery, with available pre and postoperative computed tomography-scans, were retrospectively included into the study. The following parameters were collected: (1) age at surgery, (2) duration of the procedure, (3) surgical technique, (4) fronto-nasal angle before and after surgery and (5) forehead width before and after surgery.
Results:
Ten patients aged between 15 months and 6 years were retrospectively included. Delayed surgery was due to late presentation or initial parental reluctance. All patients presented with a transversal narrowing of the forehead and an anterior bulge. Mean age at surgery was 28 months and mean follow up was 23 months (1-4 years). Measurements showed significant improvement of both the fronto-nasal angle and the width of the forehead.
Conclusions:
Late-presenting scaphocephalic patients operated on after 12 months of age require forehead remodeling to achieve satisfactory aesthetic results. Modified forehead remodeling by splitting the forehead sagittally into 2 symmetrical halves and adding a midline bone strip is a safe and feasible way to widen the forehead. Long term follow-up is needed to assess this modified technique.
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