A simple technique for the correction of frontal bossing in synostotic scaphocephaly

Biparietal remodelling and total vault remodelling in scaphocephaly-a comparative study using 3d stereophotogrammetry

PURPOSE

The aim of the study was to compare the results of two surgical techniques for the treatment of isolated sagittal synostosis (ISS) by means of 3D stereophotogrammetry. One technique, the Renier's "H" technique (RHT) comprised a biparietal expansion, the other, the total vault remodeling (TVR) included also a frontal remodeling.

METHODS

The two groups of operated children were compared with a third control group of normocephalic children. The 3D scanning was performed in all children between 12 and 245 months of age. On each 3D image six measurements and indices have been made, with the aim of evaluating not only length and width of the head, but also the height. The cranial index (CI) was measured in a plane parallel to the nasion-tragus plane, at the intersection with the opisthocranion.

RESULTS

Each of the three groups (RHT, TVR, control group) included 28 children. The measurements that were influenced by the correction of the frontal bossing, namely the CI and the sagittal length, were closer to normocephaly after TVR than after RHT. Lesser or no statistical difference was documented in the measurements evaluating the biparietal aspect and the height of the vertex, indicating that the biparietal expansion is effective in both procedures.

CONCLUSION

Based on our results TVR results in a better esthetical outcome, particularly in relation to the direct surgical remodeling of the frontal bossing.

Evaluation of Direct Surgical Remodeling of Frontal Bossing in Patients With Sagittal Synostosis

BACKGROUND

The need for surgical correction of frontal bossing in patients with sagittal synostosis is currently debated. The authors retrospectively analyzed frontal bossing in patients with isolated, nonsyndromic sagittal synostosis who underwent calvarial remodeling with and without frontal craniotomy and compared with control subjects.

METHODS

The authors analyzed computed tomography (CT) scans of patients with sagittal synostosis <9 months of age (6.2 ± 1.6 months) who underwent modified-pi procedure either with frontal craniotomy (FC, n = 15) or without frontal craniotomy (NFC, n = 10). Only patients treated with both pre-operative and 1-year post-operative CT scans were included. Non-synostotic age-matched control scans were also analyzed. Cephalic index (CI), 3 previously validated measures of frontal bossing (bossing angle, horizontal bossing ratio, and vertical bossing ratio), and pre-nasion volume ratio were obtained. Additionally, three-dimensional photographs of 10 FC patients were evaluated for frontal bossing between 1 and 8 years post-operatively.

RESULTS

Pre-operatively, no significant differences were found between the 2 groups (.064<P < 0.940). Both groups showed greater scaphocephaly and frontal bossing compared to controls (P < 0.001). One-year post-operatively, all measures improved but remained significantly different than normal values except: CI of NFC patients (P = 0.296); bossing angle (P = 0.068) and horizontal bossing ratio (P = 0.129) of FC patients. Compared to NFC patients, horizontal bossing ratio was significantly improved in FC patients (P = 0.017, mean difference of 0.047). No other statistically significant differences were found between the 2 techniques (0.127<P < 0.637).In our long-term study of FC patients up to 9 years of age (n = 10), the authors analyzed forehead inclination as our measure of frontal bossing in three-dimensional photographs. A linear regression analysis showed a significant reduction in forehead inclination with age, decreasing 1.3 ± 0.4 degrees per year (P = 0.021). Forehead inclination for controls did not change significantly with age (P = 0.558).

CONCLUSIONS

At 1-year following modified-pi procedure, FC patients approached normalization of their forehead morphology to a greater extent than NFC patients. However, neither group completely normalized during this time period. Frontal bossing in FC patients continued to decrease with age, which reveals the post-operative dynamic nature of frontal bone morphology during childhood for these patients.

Endoscopic correction of frontal bossing

BACKGROUND

Frontal bossing is a displeasing prominence of the supraorbital area. Aesthetic correction has been described as an open surgical technique. This report introduces an endoscopic approach to correction.

METHODS

A retrospective review was performed on all patients who underwent endoscopic repair of frontal bossing from 2002 to 2009. Demographics, intraoperative and postoperative course, and outcome variables were collected. Standardized preoperative and postoperative photographs were used for analysis. Aesthetic improvement of the forehead was assessed with a four-point scale (1 = no improvement at all, 4 = significant improvement) by six randomly selected observers. Preoperative facial imaging (lateral skull radiography or computed tomography) was obtained on all patients to assess the thickness of the anterior wall of the frontal sinus.

RESULTS

Ten patients met the study inclusion criteria. Overall, the observers assessed the degree of frontal bossing correction as moderate improvement (2.67 on a four-point scale survey). All endoscopic frontal bossing corrections were performed on an outpatient basis by the senior author (B.G.). No patient was admitted to the hospital for postoperative complications. No complications (such as alopecia, hematoma, contour deformities, or penetration into the frontal sinus) were seen. The limiting factor in achieving optimal outcomes was inadequate thickness of the anterior wall of the frontal sinus. All patients had various concurrent facial rejuvenation procedures.

CONCLUSIONS

Endoscopic correction of frontal bossing is an effective and safe surgical technique in forehead aesthetics. This technique is ideal for patients with a mild frontal bossing deformity who have an adequately thick anterior frontal sinus wall.

Immediate spontaneous shape correction using expantile zigzag craniectomy in infantile scaphocephaly -is there an improvement in the developmental quotient following surgery?-

There is still debate over which method of the surgery is the most appropriate for the treatment of scaphocephalic infants. In addition, change in psychomotor development following these procedures is a very complex issue that has not yet been resolved. In this paper, the authors describe a surgical technique for immediate spontaneous shape correction of infantile scaphocephaly. There were significant differences between pre- and postoperative cephalic index. We also describe an improvement in the developmental quotient following surgery. Therefore, this expantile zigzag craniectomy should be recommended to correct for isolated sagittal craniosynostosis in infants.

Posterior calvarial augmentation in premature craniosynostosis: a technique avoiding foreign implants or free bone flaps

BACKGROUND

A surgical technique of posterior calvarial augmentation without the use of plates or screws and avoiding the formation of free bone flaps is described.

DISCUSSION

Three infants with strong occipital flattening successfully underwent the procedure in their first year of life. There were no intra- or postoperative complications; the amelioration of the head shape and the cosmetic results in all three cases were convincing also in the long term.

CONCLUSION

The proposed surgical technique is both feasible and effective; it is recommended for infants with marked flat deformation of the posterior calvaria in the first year of life.