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Forehead Shape Analysis following Surgical and Conservative Treatment in Metopic Synostosis: A 3-Dimensional
Pauline A E Tio1, Tareq Abdel Alim2,3, Gennady Roshchupkin3,4
1From the Departments of Plastic and Reconstructive Surgery.
Background:
The aim of this study was to describe and compare head shape in surgically and conservatively treated patients with isolated metopic synostosis using 3-dimensional photogrammetry.
Methods:
A retrospective review (2017 through 2020) of consecutive patients, age 4 years, with isolated metopic synostosis based on 3-dimensional photogrammetry was conducted. Images were aligned using a template based on healthy age-matched controls, and mean head shapes were reconstructed to evaluate shape development. A comparative subanalysis based on phenotype was performed between patients who were treated surgically and those who were treated conservatively.
Results:
A total of 44 patients with isolated metopic synostosis were included: 22 received conservative treatment and 22 underwent fronto-orbital advancement. At 4 years of age, the surgical group showed retrusion of the complete frontal area, whereas the conservative group showed a slight frontal prominence. Both groups showed temporal depression with respect to the controls. In the subanalysis, a similar degree of temporal depression was observed between surgical and conservative treatment. Head shape patterns showed considerable similarity across all severity phenotypes.
Conclusions:
This study shows a deviation in forehead shape from normal controls in patients with metopic synostosis following both surgical and conservative treatment by age 4 years. Comparison between surgical and conservative treatment shows a similar degree of temporal depression, a slight prominence in the center of the forehead in the conservative group, and retrusion of the entire frontal area in the surgical group. This observed difference is of considerable similarity across all severity types.
Clinical Question/Level Of Evidence:
Therapeutic, III.
