title: An evaluation of complications, revisions, and long-term aesthetic outcomes in nonsyndromic metopic craniosynostosis.
abstract: BACKGROUND
  The authors evaluated the complications, revisions, and long-term aesthetic outcomes of patients with isolated metopic synostosis.
  
  
  METHODS
  A retrospective chart review was performed on consecutive metopic craniosynostosis patients treated from June of 1987 to June of 2012 at The Children's Hospital of Philadelphia. Patient demographics, operative details, and postoperative data were collected. Outcomes were reported as Whitaker classification and postoperative clinical characteristics assessed before additional interventions. Reoperation in patients with greater than 5 years of follow-up was noted. Appropriate statistical analyses were applied.
  
  
  RESULTS
  From 1987 to 2012, 178 patients underwent surgical correction of isolated metopic craniosynostosis, and 147 met inclusion criteria. Average age at surgery was 0.83 year (range, 0.3 to 4.7 years); average follow-up was 5.8 years (range, 1.0 to 17.8 years). There were 13 surgical complications (8.8 percent), three major (2.0 percent), and 10 minor (6.8 percent). At follow-up, 67 patients (56.8 percent) were classified as Whitaker class I, six (5.1 percent) as class II, 43 (36.4 percent) as class III, and two (1.7 percent) as class IV. Patients with greater than 5 years' follow-up (n = 57) were more likely to have temporal hollowing (OR, 2.9; 95 percent CI, 1.2 to 7.3; p = 0.021), lateral orbital retrusion (OR, 4.9; 95 percent CI, 1.9 to 12.7; p = 0.001), and Whitaker class III or IV classification (OR, 4.0; 95 percent CI, 1.5 to 10.6; p = 0.006) compared with those with less than 5 years' follow-up.
  
  
  CONCLUSIONS
  This study reports low complication and reoperation rates in the treatment of isolated metopic craniosynostosis, but demonstrates a clear trend toward worsening aesthetic outcomes over time.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Philadelphia, Pa. From the Division of Plastic Surgery, the Perelman School of Medicine at the University of Pennsylvania, and The Children's Hospital of Philadelphia.
authors.forename: Ari M
authors.initials: AM
authors.lastname: Wes
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Paliga
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Goldstein
authors.forename: Linton A
authors.initials: LA
authors.lastname: Whitaker
authors.forename: Scott P
authors.initials: SP
authors.lastname: Bartlett
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Taylor
mesh_terms: D016025:Bone Transplantation; D002675:Child, Preschool; D003398:Craniosynostoses / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome