title: Comparing two fronto-orbital advancement strategies to treat trigonocephaly in metopic synostosis.
abstract: BACKGROUND
  Trigonocephalic treatment entails frontoorbital reshaping of the forehead, increasing bitemporal dimensions, and advancing lateral orbits. Various techniques can achieve this, but no consensus exists regarding effects on long-term skull growth. Overcorrecting forehead dimensions is one strategy though preserving a vascularized fronto-orbital bar can influence future growth. We therefore seek to craniomorphologically compare fronto-orbital advancement (FOA), using bandeau widening and advancement, to a pedicled "tilt" procedure to assess whether adequate 3D remodeling is achieved.
  
  
  METHODS
  Demographic and computed tomographic data was recorded. Pre- and post-craniometric measurements were performed for the endocranial bifrontal angle, orbital plane angle, anterior advancement and the interzygomaticofrontal suture distance.
  
  
  RESULTS
  40 CT scans were analyzed, with similar demographics. No perioperative complications were encountered. The endocranial bifrontal angle increased in the FOA (p = 0.00026) and tilt groups (p = 0.00297), along with the orbital plane angles (FOA, p = 0.020498; tilt, p = 0.07371), the anterior advancement (FOA, p = 0.00932; tilt, p = 0.05823), and the interzygomaticofrontal suture distance (FOA, p = 0.001241; tilt, p = 0.07811).
  
  
  CONCLUSIONS
  Both techniques improve frontoorbital dimensions for correction of metopic synostosis. In severe trigonocephaly phenotypes, the FOA allows a greater magnitude of expansion and overcorrection, but compromises preservation of a vascularized leash. The "tilt" procedure possesses the benefit of near-anatomic bandeau remodeling, while potentially improving long-term growth.
authors.affiliation: Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar St, BB 3rd Floor, New Haven, CT 06520, USA.
authors.forename: Philipp
authors.initials: P
authors.lastname: Metzler
authors.affiliation: Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar St, BB 3rd Floor, New Haven, CT 06520, USA.
authors.forename: Harib H
authors.initials: HH
authors.lastname: Ezaldein
authors.affiliation: Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar St, BB 3rd Floor, New Haven, CT 06520, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Persing
authors.affiliation: Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar St, BB 3rd Floor, New Haven, CT 06520, USA. Electronic address: derek.steinbacher@gmail.com.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Steinbacher
mesh_terms: D002508:Cephalometry / Q000379:methods; D003393:Cranial Sutures / Q000002:abnormalities / Q000473:pathology / Q000601:surgery; D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009915:Orbit / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D015050:Zygoma / Q000473:pathology / Q000601:surgery
keywords: Fronto-orbital advancement; Metopic; Metopic synostosis; Suture; Tilt procedure; Trigonocephaly