title: Surgical treatment of trigonocephaly: technique and long-term results in 48 cases.
abstract: OBJECTIVE
  The authors present their experience in the surgical treatment of metopic synostosis by orbital bandeau remodeling and frontal bone rotation. The pitfalls and advantages of the surgical technique are discussed, along with the long-term clinical results in 48 consecutive cases.
  
  
  METHODS
  Forty-eight consecutive patients in whom trigonocephaly was diagnosed between 1990 and 2009 were treated with frontal bone rotation and frontoorbital bandeau remodeling. Of these patients, 38 (79%) were boys and 10 (21%) were girls. The age at the time of surgical treatment ranged between 4 and 42 months (mean ± SD 11.4 ± 8.7 months). The average follow-up period was 5.5 ± 4.2 years (range 5 months-19 years). The preoperative and latest postoperative photographs of the patients were evaluated for the following features: 1) shape of the forehead; 2) hypotelorism; and 3) temporal depression. Scores of 0, 1, or 2 were assigned for each item: 0 was normal, 1 meant moderate deformity, and 2 denoted severe deformity.
  
  
  RESULTS
  In the early postoperative period, no complications were documented. The average hospitalization period was 4 days. Follow-up radiographs or 3D CT scans were obtained at regular intervals. The mean preoperative scores for the evaluated items were 1.38 ± 0.49 for the shape of the forehead, 1.33 ± 0.48 for hypotelorism, and 1.7 ± 0.46 for the temporal depression. The mean postoperative scores were 0.06 ± 0.24 for the shape of the forehead, 0.21 ± 0.4 for hypotelorism, and 0.67 ± 0.48 for the temporal depression. Overall, the total preoperative score dropped from 4.4 to 0.93 postoperatively (p < 0.05). All the patients were contented with the cosmetic results.
  
  
  CONCLUSIONS
  Early detection and treatment of metopic suture synostosis has a significant, favorable influence on the outcomes. Good understanding of the structural abnormality and the pathophysiological mechanisms of the possible complications is very important for performing proper surgical reconstruction.
authors.affiliation: Department of Neurosurgery, Cerrahpasa Medical Faculty,Istanbul University, Istanbul, Turkey
authors.forename: Fatma
authors.initials: F
authors.lastname: Ozlen
authors.forename: Ali Metin
authors.initials: AM
authors.lastname: Kafadar
authors.forename: Bashar
authors.initials: B
authors.lastname: Abuzayed
authors.forename: Mustafa Onur
authors.initials: MO
authors.lastname: Ulu
authors.forename: Cihan
authors.initials: C
authors.lastname: Isler
authors.forename: Reza
authors.initials: R
authors.lastname: Dashti
authors.forename: Pamir
authors.initials: P
authors.lastname: Erdincler
mesh_terms: D002675:Child, Preschool; D003393:Cranial Sutures / Q000601:surgery; D003398:Craniosynostoses / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012886:Skull / Q000601:surgery; D016896:Treatment Outcome