gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Fronto-orbital advancement in trigonocephalus: surgical technique and long-term clinical results

Fronto-orbitales Advancement beim Trigonozephalus: Technik und klinische Lanzeitergebnisse

Meeting Abstract

  • corresponding author J. Regelsberger - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf
  • M. Vesper - Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Hamburg-Eppendorf
  • T. Ries - Neuroradiologische Abteilung, Universitätsklinikum Hamburg-Eppendorf
  • K. H. P. Bentele - Neuropädiatrische Abteilung, Universitätsklinikum Hamburg-Eppendorf
  • W. J. Höltje - Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Hamburg-Eppendorf

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc10.05.-11.08

The electronic version of this article is the complete one and can be found online at:

Published: May 4, 2005

© 2005 Regelsberger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




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.


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.


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.


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.