Coronal suture transplantation to correct fronto-orbital constriction in metopic synostosis

Surgical correction of non-syndromatic trigonocephaly is generally considered to be ideally performed at the age of 3 to 6 months. Conventional procedures include flattening of the forehead and straightening of the supraorbital bar by multiple osteotomies. Hypotelorbitism is generally not addressed. Long-term follow-up studies have shown that the orbital configuration does not improve spontaneously. Recently, some centres have proposed simultaneous correction of hypotelorbitism by a median widening osteotomy in the supraorbital bar. In our opinion, these procedures are indicated for patients over the age of 2 years, since further transverse growth is restricted by the plates and bone grafts in the glabella region. A procedure is presented by which both the initial and presumably the long-term correction of the transverse constriction in the forehead, glabella and orbital region is safeguarded by midline transplantation of a suitable piece of coronal sutural area.