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Cohen Steven R. M.D.; Maher, Hazem M.D.; Wagner, Jeffrey D. M.D.; Dauser, Robert C. M.D.; Newman, M. Haskell M.D.; Muraszko, Karin M. M.D.
Plastic and Reconstructive Surgery: November 1994

Analysis of intermediate- and long-term results of surgical treatment of metopic synostosis is lacking. We therefore retrospectively studied 23 patients with metopic synostosis (14 males, 9 females) who have been followed from 3 months to 8.1 years (mean 42.5 months) after operation. Age at first operation ranged from 2 to 56 months (mean 8.2 months), with 15 patients operated on before 6 months and 8 after 7 months. Fronto-orbital remodeling and calvarial vault reshaping with floating forehead techniques were carried out in all patients. Stabilization of bony segments was accomplished with microplates and screws in 7 patients (30 percent), wires in 15 (65 percent), and absorbable sutures in 1. Complications included minor wound dehiscence (n = 1), seizures (n = 1), and increased intracranial pressure (n = 1). Postoperative photographic documentation of surgical results was avaiable in 17 of the 23 patients. Aesthetic outcome in these 17 patients was graded (I = none or minor contour irregularities; II = moderate; and III = severe) by one of the authors (Cohen) and by a lay panel (n = 3) according to the degree of residual cranio-orbital deformity. Judged by the surgeon, grade I results were present in 53 percent, grade II in 35 percent, and grade III in 12 percent. To date, total reoperation (reoperative fronto-orbital remodeling and calvarial vault reshaping) was necessary in 2 patients (9 percent), one of whom had signs of increased intracranial pressure 3 years after the original craniofacial procedure, while partial reoperation (temporal cranioplasty) was carried out (n = 2) or recommended (n = 3) in another 5 patients.

When outcomes were analyzed critically, aesthetic results appeared to be superior in the group stabilized with plates and screws, although follow-up times were shorter (mean 14.6 months) than for patients undergoing fronto-orbital remodeling with wire osteosynthesis (mean 54.5 months). Serial postoperative photographs, which were available in 10 patients, showed that forehead deformities worsened over time in 1 patient but were stable in the remaining 9.

©1994American Society of Plastic Surgeons