METOPIC SYNOSTOSIS - EVALUATION OF AESTHETIC RESULTS

Analysis of intermediate- and long-term results of surgical treatment of metopic synostosis is lacking. We therefore retrospectively studied 23 patients with metopic synostosis (14 males, 9 females) who have be en followed from 3 months to 8.1 years (mean 42.5 months) after operat ion. Age at first operation ranged from 2 to 56 months (mean 8.2 month s), with 15 patients operated on before 6 months and 8 after 7 months. Fronto-orbital remodeling and calvarial vault reshaping with floating forehead techniques were carried out in all patients. Stabilization o f bony segments was accomplished with microplates and screws in 7 pati ents (30 percent), wires in 15 (65 percent), and absorbable sutures in 1. Complications included minor wound dehiscence (n = 1), seizures (n = 1), and increased intracranial pressure (n = 1). Postoperative phot ographic documentation of surgical results was available in 17 of the 23 patients. Aesthetic outcome in these 17 patients was graded (I = no ne or minor contour irregularities; II = moderate; and III = severe) b y one of the authors (Cohen) and by a lay panel (n = 3) according to t he degree of residual cranio-orbital deformity. Judged by the surgeon, grade I results were present in 53 percent, grade II in 35 percent, a nd grade III in 12 percent. To date, total reoperation (reoperative fr onto-orbital remodeling and calvarial vault reshaping) was necessary i n 2 patients (9 percent), one of whom had signs of increased intracran ial pressure 3 years after the original craniofacial procedure, while partial reoperation (temporal cranioplasty) was carried out (n = 2) or recommended (n = 3) in another 5 patients. When outcomes were analyze d critically, aesthetic results appeared to be superior in the group s tabilized with plates and screws, although follow-up times were shorte r (mean 14.6 months) than for patients undergoing frontoorbital remode ling with wire osteosynthesis (mean 54.5 months). Serial postoperative photographs, which were available in 10 patients, showed that forehea d deformities worsened over time in 1 patient but were stable in the r emaining 9.