Non-syndromic trigonocephaly: surgical decision making and long-term cosmetic results

• Published in: Child's nervous system Vol. 23; no. 11; pp. 1285 - 1289
• Main Authors: Kelleher, Michael O, Murray, Dylan J, McGillivary, Anne, Kamel, Mahmoud H, Allcutt, David, Earley, Michael J
• Format: Journal Article
• Language: English
• Published: Germany 01.11.2007
• Subjects: Child; Child, Preschool; Cranial Sutures - abnormalities; Cranial Sutures - surgery; Craniosynostoses - surgery; Esthetics; Female; Humans; Infant; Male; Orthopedic Procedures - methods; Patient Satisfaction; Retrospective Studies; Severity of Illness Index; Skull - surgery; Treatment Outcome
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-007-0386-6

Surgical correction is often required for cosmetic correction of trigonocephaly. The purpose of this paper was to report the long-term aesthetic outcome as appreciated by the parents/patients themselves. The self-evaluation of cosmetic outcome after trigonocephaly correction has not previously been reported. The management and different surgical techniques utilized over a 16-year period are discussed. An observational study was undertaken of the clinical outcome, operative data, complications and cosmetic satisfaction of these trigonocephaly patients. The parents/child were asked to rate their satisfaction with the cosmetic outcome both in terms of head shape and scar appearance, on a five-point scale (excellent-5, very good-4, good-3, fair-2 and poor-1). Sixty-three patients presented with non-syndromic trigonocephaly over the 16 years. Nineteen of 63 had a mild form of trigonocephaly and were managed conservatively. The remainder underwent surgical correction. Forty-two of 44 (95%) underwent fronto-orbital advancement with either barrel staving (26/44) or frontal bone rotation/re-modelling (16/44), with 2 of 44 having burring of the metopic ridge. Head shape rating was regarded as excellent in 25 of 63 (40%), very good in 18 of 63 (28%), good in 18 of 63 (28%) and fair in 2 of 63 (4%). Of those that underwent surgery, the scar was zigzag in 32 of 44 and straight in 12 of 44. Scar was rated as being excellent in 21 of 44 (48%), very good in 12 of 44 (28%) good in 11 of 44 (24%). Metopic synostosis can result in varying degrees of severity. Milder forms can be treated conservatively, with more severe forms requiring both frontal bone re-modelling and fronto-orbital advancement. Surgical correction results in a high level of patient/parent satisfaction.