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In Situ Hinge Technique for the Frontal Bandeau for the Correction of Metopic Craniosynostosis Reduces Operative Time

Magoon, Katie, MSN, MPA; Azzolini, Anthony, MD; Yang, Robin, MD; Taylor, Jesse, MD

doi: 10.1097/SCS.0000000000005459
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Background and Purpose: Treatment of metopic craniosynostosis often involves bitemporal expansion of the anterior cranium. This report compares perioperative variables of a surgical technique in which the fronto-orbital bandeau is bent in situ to traditional fronto-orbital advancement and remodeling (FOAR).

Method/Description: Six patients undergoing the hinge technique were compared to the senior author's 6 most recent conventional FOARs. Study and control cohorts were reasonably well matched for age and sex; only those with nonsyndromic, single-suture metopic synostosis were included. Perioperative variables such as OR time, blood loss, hardware costs, length of stay, and perioperative complications were compared between groups using unpaired t tests.

Results: Operative time was significantly decreased when the hinge technique was utilized, with a mean operative time of 159 ± 14.0 minutes for hinge patients and 193 ± 33.8 minutes for nonhinge patients (P = 0.049). Hardware was also significantly decreased from an average of 2.2 ± 1.0 plates and 35 ± 13.8 screws in nonhinge patients to 1 plate and 20 screws in each hinge patient (P < 0.02), for an average hardware saving of $2990 per hinge surgery (P = 0.019). Estimated blood loss, length of stay, and perioperative complications were not significantly different between groups. All patients in both groups had Whitaker 1 outcomes in short-term follow-up.

Conclusions: The hinge technique for the treatment of metopic synostosis is associated with a statistically significant decrease in operative time, hardware utilization, and hardware cost. Perioperative outcomes were similar between the hinge technique and traditional FOAR in the short term, and additional follow-up is needed to determine whether the 2 have similar long-term outcomes.

Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.

Address correspondence and reprint requests to Jesse Taylor, MD, Chief of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Perelman Center for Advanced Medicine, South Tower, 14th Floor, Philadelphia, PA 19104; E-mail: jataylor@gmail.com

Received 12 December, 2018

Accepted 11 February, 2019

The authors report no conflicts of interest.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com).

© 2019 by Mutaz B. Habal, MD.