title: Three patterns of fronto-orbital remodeling for metopic synostosis: comparison of cranial growth outcomes.
abstract: BACKGROUND
  The authors compared cranial growth across three patterns of fronto-orbital remodeling for metopic synostosis.
  
  
  METHODS
  The authors reviewed all patients who underwent fronto-orbital remodeling for isolated metopic synostosis between 2006 and 2009. Inclusion criteria consisted of patients with preoperative, short-term postoperative (4 to 12 months), and long-term postoperative (>36 months) three-dimensional photographs. Patients were categorized by fronto-orbital remodeling pattern: group 1, retrocoronal; group 2, partial coronal; and group 3, precoronal. Head circumference, minimum frontal breadth (ft-ft), and maximum cranial length were measured by three-dimensional photographs, converted to standard Z scores, and compared.
  
  
  RESULTS
  Thirty-one patients met inclusion criteria (group 1, n=12; group 2, n=10; and group 3, n=9). Group 1 presented with the greatest phenotypic severity. From preoperative to short-term postoperative assessment, head circumference Z scores rose for group 1 but dropped for groups 2 and 3, and the three groups demonstrated equivalent increases in minimum frontal breadth Z scores. From short-term to long-term postoperatively, the three groups demonstrated similar stability in head circumference Z scores but decreased minimum frontal breadth Z scores. From preoperatively to long-term postoperatively, head circumference Z scores rose for group 1 but fell for groups 2 and 3 (change in Z score, 0.5, -0.5, and -0.7, respectively; p=0.06) and the three groups demonstrated equivalent drops in minimum frontal breadth Z scores. Across preoperative to short-term postoperative and preoperative to long-term postoperative assessment, group 1 displayed the least drop in maximum cranial length Z scores.
  
  
  CONCLUSIONS
  Retrocoronal patterns of fronto-orbital remodeling provide long-term gains in head circumference percentile and the least growth impairment in cranial length. Irrespective of osteotomy design, expansion in frontal breadth relapses significantly over time.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Melbourne, Victoria, Australia From the Departments of Plastic and Maxillofacial Surgery and Neurosurgery, Royal Children's Hospital Melbourne; and the Department of Paediatrics, University of Melbourne.
authors.forename: Mitchel
authors.initials: M
authors.lastname: Seruya
authors.forename: Shi Hong
authors.initials: SH
authors.lastname: Shen
authors.forename: Luke L
authors.initials: LL
authors.lastname: Wang
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Penington
authors.forename: Alison C
authors.initials: AC
authors.lastname: Wray
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Greensmith
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Holmes
authors.forename: David K
authors.initials: DK
authors.lastname: Chong
mesh_terms: D001315:Australia; D002508:Cephalometry / Q000379:methods; D015331:Cohort Studies; D003398:Craniosynostoses / Q000000981:diagnostic imaging / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006776:Hospitals, Pediatric; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008297:Male; D009915:Orbit / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012886:Skull / Q000254:growth & development; D016896:Treatment Outcome