title: The Christmas tree foreheadplasty: a novel technique used in combination with a bandeau for fronto-orbital remodelling in craniosynostosis.
abstract: OBJECTIVE
  Craniosynostosis of the coronal, metopic and frontosphenoidal sutures results in deformity of the forehead. This may cause both functional and psychological difficulties for patient and parent. We describe a novel surgical technique, the 'Christmas tree foreheadplasty', used in combination with a supraorbital bandeau to achieve fronto-orbital remodelling.
  
  
  METHODS
  Between November 2008 and September 2011, 32 patients with craniosynostosis underwent fronto-orbital remodelling with a supraorbital bandeau in combination with Christmas tree foreheadplasty. Indications for surgery, age at surgery, blood transfusion requirements, length of hospital stay and perioperative complications were assessed. A 'blinded', independent reviewer, age-matched controlled, panel photograph study was also undertaken to review results of the surgery. A parental satisfaction survey by telephone questionnaire was undertaken.
  
  
  RESULTS
  Mean age at surgery was 16 months. Average hospital stay was 3 days. Mean follow up time to this report was 19.5 months. Indications for the procedure included unicoronal, frontosphenoidal, metopic and bicoronal synostosis. Thirty of the 32 patients required a blood transfusion. One patient has required revision surgery following extrusion of prosthetic fixation plate. Surgical outcome measured by 'blinded' independent reviewers indicated that a significantly different preoperative score from normal was rendered to no significant difference from age-matched normal controls postoperatively. Parental satisfaction score of forehead appearance was significantly improved by the technique.
  
  
  CONCLUSIONS
  The Christmas tree foreheadplasty is a commendable and reproducible technique for forehead remodelling in combination with supraorbital bandeau and is now used more widely for forehead reconstruction for congenital cases.
authors.affiliation: The Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK. j.britto@doctors.org.uk
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Britto
authors.forename: Ivo
authors.initials: I
authors.lastname: Gwanmesia
authors.forename: David
authors.initials: D
authors.lastname: Leshem
mesh_terms: D003398:Craniosynostoses / Q000601:surgery*; D003625:Data Collection; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005546:Forehead / Q000601:surgery*; D005624:Frontal Bone / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents / Q000523:psychology; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome