Hypotelorism in Metopic Craniosynostosis: Persistent Undercorrection Following Open Cranial Vault Remodeling

Area of Science:

• Craniofacial Surgery
• Pediatric Neurosurgery
• Plastic Surgery

Background:

• Metopic craniosynostosis results from premature metopic suture fusion, causing trigonocephaly and hypotelorism.
• Open fronto-orbital advancement and cranial vault remodeling (FOA/CVR) is a common surgical treatment.
• The impact of FOA/CVR on hypotelorism, specifically bony interorbital distance (BIOD), is not fully understood.

Purpose of the Study:

• To evaluate changes in BIOD and other craniometric parameters after FOA/CVR in pediatric patients with isolated metopic craniosynostosis.
• To compare postoperative BIOD with age-matched normative values.

Main Methods:

• Retrospective study of 19 pediatric patients with isolated metopic craniosynostosis undergoing FOA/CVR.
• Exclusion of syndromic, multisuture, or minimally invasive cases.
• Analysis of pre- and postoperative CT scans for BIOD, interzygomaticofrontal distance, orbital rim angles, and endocranial bifrontal angle.

Main Results:

• FOA/CVR significantly increased interdacryon distance (BIOD) from 13.35 mm to 14.81 mm (P=0.0296).
• Interzygomaticofrontal distance also significantly increased (68.46 mm to 77.54 mm, P=0.0005).
• Orbital rim angles and endocranial bifrontal angle showed no significant changes; postoperative BIOD remained below normative values.

Conclusions:

• Standard open FOA/CVR provides measurable improvement in bony interorbital distance for metopic craniosynostosis.
• Undercorrection of hypotelorism is a common finding at least one year postoperatively.
• Further surgical strategies may be needed to fully address hypotelorism in these patients.