Evaluating long-term outcomes of fronto-orbital advancement in metopic synostosis: insights from 3D photogrammetry

Current literature on long-term surgical outcomes in patients with metopic synostosis is highly heterogeneous, with inconsistent outcome measures and varying follow-up durations. As a result, there is a lack of reliable data on post-surgical outcomes in late adolescence. The primary objective of this study was to objectively evaluate the long-term outcomes at skeletal maturity following fronto-orbital advancement (FOA) in patients with metopic synostosis.

All patients with isolated metopic synostosis who underwent FOA at Sophia Children's Hospital between 2003-2008 were included. Their data were retrospectively reviewed. Head shape analysis was performed on all available 3D images of patients with metopic synostosis at their last follow-up appointment. CranioRate was used to determine pre-operative severity.

The total cohort consists of 107 patients, who underwent FOA at the median age of 11 months [IQR 9-12]. Head shape analysis on available 3D images at the age of 17 years (n = 48) showed that patients exhibit notable differences in forehead shape compared to healthy controls, characterized by frontal retrusion and temporal depressions. At late adolescence, 3.7% of patients with metopic synostosis who underwent FOA opted for a secondary recontouring procedure using PMMA. No significant differences were observed in factors such as age at primary surgery, sex, and pre-operative severity between those who underwent secondary recontouring and those who did not.

At the age of 17 years, patients with metopic synostosis following FOA have evident temporal depressions and frontal retrusion. Initial severity had a minimal effect on these deformities.