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Anthropometric Outcome Measures in Patients With Metopic Craniosynostosis

Farber, Scott J. MD*; Nguyen, Dennis C. MD*; Skolnick, Gary B. BS*; Naidoo, Sybill D. PhD, CPNP*; Smyth, Matthew D. MD; Patel, Kamlesh B. MD*

Journal of Craniofacial Surgery: May 2017 - Volume 28 - Issue 3 - p 713–716
doi: 10.1097/SCS.0000000000003495
Original Articles

Purpose: Treatment of metopic craniosynostosis is performed by either fronto-orbital advancement (FOA) or endoscopic-assisted techniques. Interfrontal angle (IFA) is a validated measure of trigonocephaly, but requires a computed tomography scan. The most common direct measure to assess surgical outcome in patients with trigonocephaly is frontal width (ft–ft). The aim of this study is to determine if frontal width correlates with IFA and successful surgical correction 1 year after treatment. A review of current morphologic assessment techniques is also provided.

Methods: Three-dimensional computed tomography scans (preoperative and 1 year postoperative) of patients who underwent FOA (n = 13) or endoscopic (n = 13) treatment of metopic craniosynostosis were reviewed. Age-matched scans of unaffected patients served as controls. Frontal width was measured by a straight line between the bilateral frontotemporal points. Measurements were performed by 2 experienced observers and compared to IFA.

Results: Mean frontal width at preoperative scan for endoscopic and open patients was 55 ± 0.6 and 64 ± 0.7 mm, respectively (Z-score 1.6 and −3.7). Mean frontal width at postoperative scan for endoscopic and open patients was 80 ± 0.4 and 81 ± 0.7 mm (Z-score 0.0 for both groups). Frontal width for endoscopic correction significantly correlated with IFA (r = 0.536, P = 0.005), as well as for the open patients (r = 0.704, P < 0.001).

Conclusion: Frontal width normalizes 1 year after operation, regardless of technique. Advantage of frontal width is that it can be measured in the clinic using a spreading vernier caliper. It correlates well with IFA and can be used as a metric for morphologic outcome.

*Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine

Department of Neurosurgery, Washington University School of Medicine, St Louis, MO.

Address correspondence and reprint requests to Scott J. Farber, MD, Division of Plastic and Reconstructive Surgery, Washington University in Saint Louis, 660 South Euclid Avenue, Campus Box 8238, St Louis, MO 63110; E-mail:

Received 13 October, 2016

Accepted 22 November, 2016

Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences (grant UL1 TR000448) from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) and Children's Discovery Institute. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.

KBP is a consultant for Stryker CMF. The other authors report no conflicts of interest.

© 2017 by Mutaz B. Habal, MD.