Long-term results in isolated metopic synostosis- the Oxford experience in 22 years.

Background: Metopic synostosis causing trigonocephaly is treated by fronto-orbital-advancement and remodelling to correct the deformity, cerebral distortion and to treat intracranial hypertension in a small number of cases. This study's aim was to evaluate complications, revisions and long-term outcomes. Methods: A retrospective chart review was performed on consecutive metopic craniosynostosis patients treated between February 1995 and February 2017 at the Oxford Craniofacial Unit. Results: 245 patients with isolated metopic synostosis were seen. 202 patients underwent fronto-orbital-advancement and remodelling. 50 (25%) female; 152 (75%) male. Mean age at surgery was 16.8 months. Mean weight preoperatively was 12kg. All patients received blood transfusion. Mean postoperative stay was 6 days. Average follow-up time was 8 years (range 0.5-22 years). There were 8 (4%) major complications. 6 (2.9%) patients required secondary calvarial-expansion for late raised intracranial pressure. 31 (15%) had other subsequent procedures including wire removal (8%) and forehead shape contouring (4%) with alloplastic onlay. Raised intracranial pressure prior to surgery was confirmed in 2 cases by intracranial pressure monitoring. Conclusion: Trigonocephaly is caused by metopic synostosis and is treated by fronto-orbital advancement and remodelling in order to restore both internal and external skull configuration. Following surgery, we identified a 2.9% risk of late raised intracranial pressure requiring a secondary calvarial-expansion, necessitating prolonged follow up in all cases. Temporal hollowing and forehead contour defects were not uncommon, resulting in a need for onlay recontouring in selected cases. This is the largest reported series of metopic synostosis. Financial disclosure statement: The authors have no financial disclosures. Presented at: 17th biennal congress of the International Society of Craniofacial Surgery (ISCFS), 24th-28th October 2017, Cancun, Mexico. Correspondence should be address to: Hamidreza Natghian M.D., Oxford Craniofacial Unit, Level LG1, West Wing, John Radcliffe Hospital, Headley Way, Headington, OX3 9DU, Oxford, United Kingdom. Email: Hamidreza.natghian@gmail.com ©2018American Society of Plastic Surgeons