title: Parallel angulated frontal bone slat cuts for treatment of metopic synostosis and other frontal skull deformities: the "cathedral dome procedure".
abstract: OBJECTIVE
  This study aims to describe a new procedure for the treatment of metopic synostosis and other frontal skull deformities.
  
  
  METHODS
  The procedure comprises a supraorbital bandeau widened with an interpositional graft and rounded laterally to eliminate the acute angle, and parallel angulated slat cuts in the frontal bones. Greenstick fracturing of the medial bases of these slats along a parasagittal hinge line causes fanning of the slats and expansion of the frontal flap both anteriorly and laterally making the forehead contour wider and more rounded. We performed this procedure on six infants (four with severe trigonocephaly from metopic synostosis, one with brachycephaly from bicoronal synostosis, and one with multiple suture synostosis and parietal flattening) for whom only the angulated slat cuts (without bandeau) were used. Each patient had preoperative three-dimensional computed tomography (3D-CT) and postoperative 3D-CT at 1 week, 3 months, and 12 months, to follow the result.
  
  
  RESULTS
  The cosmetic improvements are dramatic in eliminating the midfrontal keel, hypotelorism, frontal-lateral retrusion, and temporal hollowing seen in severe metopic synostosis. In coronal synostosis, the procedure corrects the brachycephaly and gives a balanced, well-rounded frontal contour. The end results of the fronto-orbital correction resemble the ribbed dome of a cathedral; hence, the moniker the "cathedral dome procedure". No patient needed a second procedure to fill in cranial defects or recorrect deficient areas.
  
  
  CONCLUSIONS
  The parallel angulated frontal slat cuts technique (the "cathedral dome procedure") is a straightforward and easily mastered method that reliably produces excellent result for the correction of trigonocephaly and other frontal skull deformities.
authors.affiliation: Paediatric Neurosurgery, University of California Davis, 2315 Stockton Blvd, Sacramento, CA, USA, PangTV@aol.com.
authors.forename: Dachling
authors.initials: D
authors.lastname: Pang
authors.forename: John
authors.initials: J
authors.lastname: Zovickian
authors.forename: Sui-to
authors.initials: ST
authors.lastname: Wong
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Hou
authors.forename: Hop N
authors.initials: HN
authors.lastname: Le
mesh_terms: D003398:Craniosynostoses / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012886:Skull / Q000002:abnormalities* / Q000601:surgery*
references.citation: J Plast Reconstr Aesthet Surg. 2010 Jan;63(1):36-41
references.pmid: 19036661
references.citation: Int Surg. 1996 Apr-Jun;81(2):210-4
references.pmid: 8912096
references.citation: Neurosurg Clin N Am. 1991 Jul;2(3):621-7
references.pmid: 1821308
references.citation: Br J Plast Surg. 1994 Jun;47(4):211-22
references.pmid: 8081607
references.citation: Childs Nerv Syst. 1996 Nov;12(11):654-63
references.pmid: 9118127
references.citation: Ann Plast Surg. 2007 Jul;59(1):6-13
references.pmid: 17589251
references.citation: Childs Nerv Syst. 2007 Nov;23(11):1313-7
references.pmid: 17701413
references.citation: Neurosurgery. 1986 Aug;19(2):228-34
references.pmid: 3748350
references.citation: Childs Nerv Syst. 2007 Nov;23(11):1285-9
references.pmid: 17569057
references.citation: J Neurosurg Pediatr. 2011 Mar;7(3):300-10
references.pmid: 21361772
references.citation: J Neurosurg. 1990 Jan;72(1):22-6
references.pmid: 2294180
references.citation: Plast Reconstr Surg. 1978 Jun;61(6):823-35
references.pmid: 662945
references.citation: Plast Reconstr Surg. 1985 Aug;76(2):202-11
references.pmid: 4023093
references.citation: J Craniofac Surg. 2011 Jan;22(1):261-5
references.pmid: 21233734
references.citation: Plast Reconstr Surg. 2007 Mar;119(3):977-84
references.pmid: 17312504
references.citation: Neurosurgery. 1981 Feb;8(2):143-9
references.pmid: 7207779
references.citation: J Craniofac Surg. 2006 Mar;17(2):241-5
references.pmid: 16633169