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Endoscopic-Assisted Correction of Metopic Synostosis

Gociman, Barbu MD, PhD*; Agko, Mouchammed MD; Blagg, Ross MD*; Garlick, Jared BS; Kestle, John R.W. MD, MSc§; Siddiqi, Faizi MD*

Journal of Craniofacial Surgery: May 2013 - Volume 24 - Issue 3 - p 763–768
doi: 10.1097/SCS.0b013e31828696a5
Original Articles

Abstract: Our 6-year experience with correction of metopic synostosis using a minimally invasive endoscopic-assisted technique followed by postoperative cranial vault helmet molding is presented. In addition, a simple, objective method for quantification of the frontal vault contour is described.

A total of 16 patients, 13 males and 3 females, with nonsyndromic, single-suture synostosis were included in the study. Patient age at operation averaged 2.9 months and the mean weight was 6 kg. The mean operative time was 79 minutes. The estimated blood loss during the procedure was 82.8 mL. Three patients required blood transfusions (18.7%). There were no significant postoperative complications. The mean hospitalization was 1.6 days. The average surgical cost, including the helmets, was $12,400, in contrast to $33,000 charged for the equivalent open procedure.

Very good esthetic results, judged by physical examination and photograph comparison, were obtained in all patients. No relapses were noted. Objectively, the outcome of the operative repair was evaluated using laser scanning. For quantification of the distortion and the postoperative level of correction, the metopic angle was defined and used. This angle changed from preoperative value of 104.9 degrees to 111.3 degrees at 3 months (P = 1.59E−06) and to 114.9 degrees at 1 year postoperatively (P = 2.51E−09).

Due to its promising attributes, minimally invasive strip craniectomy emerges as an ideal modality for correction of metopic synostosis. Furthermore, the metopic angle should provide clinicians with an objective measure of the frontal cranial vault deformity and its correction.

From the *Division of Plastic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah; †Division of Plastic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California; ‡University of Utah Health Sciences Center, Salt Lake City, Utah; and §Division of Pediatric Neurosurgery, Primary Children’s Medical Center, Salt Lake City, Utah.

Received September 17, 2012.

Accepted for publication December 23, 2012.

Address correspondence and reprint requests to Dr. Barbu Gociman, Division of Plastic Surgery, University of Utah Health Sciences Center, 30 North 1900 East, 3B400, Salt Lake City, UT 84132; E-mail: barbu.gociman@hsc.utah.edu

The authors report no conflicts of interest.

© 2013Wolters Kluwer Health | Lippincott Williams & Wilkins