Post-Surgical Relapse in Metopic Synostosis and Limitations of the Interfrontal Angle as an Outcome Measure

Glener, Adam D.; Allori, Alexander C.; Shammas, Ronnie L.; Farjat, Alfredo E.; Marcus, Jeffrey R.

doi:10.1097/scs.0000000000003800

Cited by 5 publications

(10 citation statements)

References 26 publications

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“…While our unit has previously utilized 3D scan-derived data to define the early results achievable by the FOR technique used in this series (Rodriguez-Florez et al, 2017), what we have investigated here is a particularly unsightly deformity (Figure 1; see also Figure 5 in Glener (Glener et al, 2017) and Figure 1 in Oh (Oh et al, 2006)) more frontal than strictly temporal, that can first become apparent some three to four years following FOR for the correction of trigonocephaly associated with metopic synostosis.…”

Section: Discussionmentioning

confidence: 99%

Investigating the cause of late deformity following fronto-orbital remodelling for metopic synostosis using 3D CT imaging

Rodríguez-Flórez

Florez-Tapia

Jeelani

et al. 2019

Journal of Cranio-Maxillofacial Surgery

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Late deformity/indentation is well-recognised following fronto-orbital remodelling (FOR) for metopic synostosis. We hypothesise that if damage to temporalis muscle was a contributor, thickness of soft tissue and bone in the affected area would be reduced.Soft tissues and bone were separately segmented and 3D reconstructed from CTs of 8 patients 1.5-18 years post-FOR performed at 16±2 months for metopic synostosis and from 8 agematched controls. Soft tissue (taken as proxy for temporalis muscle) and bone thickness overall and in the indented areas were computed.Post-FOR, 3D soft tissue thickness maps demonstrated temporalis extending upwards but falling short of the indented area. Overall skull thickness increased with age post-FOR (logarithmic fit R 2 = 0.71) and for controls (R 2 =0.90). Although immediately post-FOR the future indented area had a thickness of 98% of control, it decreased linearly to 64% 16 years later (Pearson's r=0.84).These findings suggest that late post-FOR deformity/indentation is enhanced by limited upward extension (or retraction downwards) of temporalis muscle while bone thickness in the affected area gradually decreases. This supports the hypothesis that aberrant re-attachment of the temporalis muscle makes a material contribution to late deformity following FOR for metopic synostosis.

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Section: Discussionmentioning

confidence: 99%

Investigating the cause of late deformity following fronto-orbital remodelling for metopic synostosis using 3D CT imaging

Rodríguez-Flórez

Florez-Tapia

Jeelani

et al. 2019

Journal of Cranio-Maxillofacial Surgery

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“…Engel et al 11) founded that 43 patients (79.6%) had a class I outcome, 10 patients were class II, none of their patients were class III, and only one patient was class IV and frontorbital advancement was the standardized operation. Glener et al 14) showed fronto-orbital advancement provides immediate and adequate correction in supraorbital bar. Three of our patients (16.7%) need 2nd surgery (two were operated by OT and one operated by ET).…”

Section: Discussionmentioning

confidence: 99%

“…However, Nguyen et al 25) described three patients (8%) who needed a second surgery and were operated by OT and none from ET group. In the assessment of postsurgical relapse, Glener et al 14) concluded age at intervention and preoperative interfrontal angle (IFA) are the most accurate predictors. However postoperative IFA changes should not be used solely to evaluate relapse due to inherent anatomical limitations.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Surgical Management of Metopic Synostosis : A Retrospective Study of 18 Cases

Elhawary

Adawi

Gabr

2022

J Korean Neurosurg Soc

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Objective : To describe the surgical management and postoperative outcomes in infants with metopic synostosis. Methods : We conducted a 5 years retrospective chart review of patients who underwent surgical correction of metopic synostosis at two university hospitals in Egypt during the period between June 2014 and June 2019. The study is conducted to 18 children. The type of surgical procedures and postoperative outcomes were assessed in all patients. Results : Five cases (27.8%) underwent endoscopic-assisted suturectomy, 10 cases (55.6%) underwent craniofacial reconstruction, and three cases (16.6%) underwent open burring of the metopic ridge. Fifteen patients underwent one surgery and three patients (16.6%) who need second operation. Ten patients (55.6%) had class I Whitaker classification. Conclusion : Regardless of type of surgery, the outcomes of surgical correction of metopic synostosis are excellent with only a few patients require revision or develop major complications.

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“…There is no widely used, agreed upon quantitative method for evaluation of MCS, so this study chose to evaluate forehead changes with both 3D (Figure 4) and two-dimensional (2D; Figure 2 angle (Kellogg et al, 2012;Anolik et al, 2016;Glener et al, 2017;Ha et al, 2020), anthropometrics/cephalometrics (Mendonca et al, 2013;Ha et al, 2020), interfrontal-interparietal ratio (Ruiz-Correa et al, 2008), 3D contour (Cho et al, 2016), and series of 2D slices (Ruiz-Correa et al, 2008;Weathers et al, 2014). Three-dimensional surface images provided by stereophotogrammetric photography allow for full representation of the entire contour of the head without ionizing radiation (Shah et al, 2011;Engel et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Subjective assessments of outcomes have not led to a gold standard method of measuring MCS severity and treatment (Paige et al, 2003; Jaskolka, 2017; Braun et al, 2018). Some studies have attempted to quantitate outcomes by creating a single standardized scalar measurement, such as the interfrontal angle (Kellogg et al, 2012; Nguyen et al, 2015; Anolik et al, 2016; Glener et al, 2017). Yet the reduction in the complex shape of the forehead to a single measurement is similar to reducing the shape changes that occur in sagittal synostosis to a single number such as cranial index.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Head Shape Outcomes in Metopic Synostosis Using Limited Strip Craniectomy and Open Vault Reconstruction Techniques

Pressler

Hallac

Geisler

et al. 2020

The Cleft Palate-Craniofacial Journal

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Aim: Metopic craniosynostosis (MCS), with its trigonocephalic head shape, is often treated with either limited incision strip craniectomy (LISC) followed by helmet orthotic treatment, or open cranial vault reconstruction techniques (OCVR). There is controversy regarding resultant shape outcomes among craniofacial surgeons. Those adverse to LISC claim normal head shape is never attained, while proponents believe there is gradual correction to an equivalent outcome. This study aims to quantitate, over time, the three-dimensional (3D) head shapes in patients who have undergone LISC or OCVR intervention for MCS. Methods: Sixty-three 3D images of 26 patients with MCS were analyzed retrospectively. Head shape analyses were performed at: (1) preoperative, (2) 1-month postoperative, (3) 10 to 14 months postoperative (1 year), and (4) 2 years postoperative. Composite 3D head shapes of patients were compared at each time point. Two-dimensional (2D) standardized cross sections of the forehead were also compared. Results: Composite head shapes for both groups were nested, to allow visual comparison as the child’s forehead grows and expands. The difference between LISC and OCVR 2D cross sections was calculated; 108.26 mm preoperatively, 127.18 mm after 1-month postoperative, 51.05 mm after 10 to 14 months postoperative, and 27.03 mm after 2 years postoperative. Conclusions: This study found excellent head shape outcomes for both the LISC and OCVR techniques at 2 years of age. It also corroborates the slow and progressive improvement in head shape with the LISC technique. This study highlights the advantages of 3D photography for measurement of contour outcomes, utilizing both 2D vector and 3D whole head analytical techniques.

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Post-Surgical Relapse in Metopic Synostosis and Limitations of the Interfrontal Angle as an Outcome Measure

Cited by 5 publications

References 26 publications

Investigating the cause of late deformity following fronto-orbital remodelling for metopic synostosis using 3D CT imaging

Investigating the cause of late deformity following fronto-orbital remodelling for metopic synostosis using 3D CT imaging

Outcomes of Surgical Management of Metopic Synostosis : A Retrospective Study of 18 Cases

Comparison of Head Shape Outcomes in Metopic Synostosis Using Limited Strip Craniectomy and Open Vault Reconstruction Techniques

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