Non-syndromic trigonocephaly: surgical decision making and long-term cosmetic results.
BACKGROUND
Surgical correction is often required for cosmetic correction of trigonocephaly. The purpose of this paper was to report the long-term aesthetic outcome as appreciated by the parents/patients themselves. The self-evaluation of cosmetic outcome after trigonocephaly correction has not previously been reported. The management and different surgical techniques utilized over a 16-year period are discussed.


METHODS
An observational study was undertaken of the clinical outcome, operative data, complications and cosmetic satisfaction of these trigonocephaly patients. The parents/child were asked to rate their satisfaction with the cosmetic outcome both in terms of head shape and scar appearance, on a five-point scale (excellent-5, very good-4, good-3, fair-2 and poor-1).


RESULTS
Sixty-three patients presented with non-syndromic trigonocephaly over the 16 years. Nineteen of 63 had a mild form of trigonocephaly and were managed conservatively. The remainder underwent surgical correction. Forty-two of 44 (95%) underwent fronto-orbital advancement with either barrel staving (26/44) or frontal bone rotation/re-modelling (16/44), with 2 of 44 having burring of the metopic ridge. Head shape rating was regarded as excellent in 25 of 63 (40%), very good in 18 of 63 (28%), good in 18 of 63 (28%) and fair in 2 of 63 (4%). Of those that underwent surgery, the scar was zigzag in 32 of 44 and straight in 12 of 44. Scar was rated as being excellent in 21 of 44 (48%), very good in 12 of 44 (28%) good in 11 of 44 (24%).


CONCLUSIONS
Metopic synostosis can result in varying degrees of severity. Milder forms can be treated conservatively, with more severe forms requiring both frontal bone re-modelling and fronto-orbital advancement. Surgical correction results in a high level of patient/parent satisfaction.
Kelleher
Michael O
MO
Department of Neurosurgery, Beaumont Hospital, Dublin 9, Republic of Ireland. mokelleher@eircom.net
Murray
Dylan J
DJ
McGillivary
Anne
A
Kamel
Mahmoud H
MH
Allcutt
David
D
Earley
Michael J
MJ
D002648:Child; D002675:Child, Preschool; D003393:Cranial Sutures / Q000002:abnormalities / Q000601:surgery; D003398:Craniosynostoses / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012886:Skull / Q000601:surgery*; D016896:Treatment Outcome