Artikel
Fronto-orbital advancement in trigonocephalus: surgical technique and long-term clinical results
Fronto-orbitales Advancement beim Trigonozephalus: Technik und klinische Lanzeitergebnisse
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Autoren
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J. Regelsberger
- Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf
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M. Vesper
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Hamburg-Eppendorf
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T. Ries
- Neuroradiologische Abteilung, Universitätsklinikum Hamburg-Eppendorf
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K. H. P. Bentele
- Neuropädiatrische Abteilung, Universitätsklinikum Hamburg-Eppendorf
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W. J. Höltje
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Hamburg-Eppendorf
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
Metopic synostosis is characterized by trigonocephalic frontal skull shape involving the orbitae by hypotelorism. The extent of its presenting deformity decides about surgical reshaping where a variety of aggressive procedures have been advocated to correct the deficiency of lateral orbital rims and their projection anteriorly. We present our experiences with a simple fronto-orbital advancement technique.
Methods
In 16 children, 9 female and 7 male with a medium age of 5.9 months, diagnosis of trigonocephalus was confirmed by biplanar roentgenography. The extent and degree of fronto-orbital advancement was individually planned by 3D-CCT. As an elementary step supraorbital rim was removed as single piece and reshaped to normal form in all patients. Refixing in advanced position with two non-absorbable plate systems at the temporo-frontal bone and 3-0 sutures at the nasion followed removal of the orbital roof. Bifrontal cranioplasty with reshapening of the frontal bone was achieved by deviding into two parts, reorienting bone grafts in 90° rotation and performing radial osteotomies. The bone parts were refixated by 3-0 sutures.
Results
Median time of surgery was 3.1 hours. Minor complications (wound infection) were found in three patients. No major complications (bleeding, seizures) have been seen in a 6-year practice. Plate systems have not been removed and caused no complications in follow-up. Surgical results after 0.9-7 years (medium 3.4 years) revealed a satisfying cosmetic reshapening in all patients judged by the family, the clinician and the patient separately. The results were documented by radiological and photometric analyzes.
Conclusions
Even not all premature synostosis have to be operated on, due to the often non-syndromic and mild forms, we believe that surgical reshapening should be performed by an experienced team to reduce perioperative morbidity and to achieve satisfying aesthetic results. A standard fronto-orbital advancement technique, modified to some extent on the individual efforts, is a simple, safe and an effective procedure correcting trigonocephalic skull shape with involvement of the orbital rim.
