Hormozi Abdoljalil Kalantar, Shahverdiani Reza, Mohammadi Hassan Reza, Zali Alireza, Mofrad Hamid Reza Hallaj
Craniomaxillofacial Surgery Department, 15 Khordad Hospital, Tehran, Iran.
J Craniofac Surg. 2011 Jan;22(1):261-5. doi: 10.1097/SCS.0b013e3181f7b80c.
Metopic synostosis is characterized by keel-shaped forehead (trigonocephaly), prominent midline ridge of the forehead, bitemporal narrowing, bilateral retrusion of supraorbits, egg-shaped orbits, low nasal dorsum, and reduced volume of the anterior cranial fossa. The mainstay treatment is early surgical intervention before the age of 12 months, which usually consists of bifrontal craniotomy with bilateral recontouring, lateral advancement, and lateral displacement of the superior orbital rims. Here, we have developed a new simplified technique for surgical treatment of trigonocephaly. A total of 60 cases of trigonocephaly were operated on between January 1995 and January 2010 by the first author. Surgical outcomes were evaluated 6 months after surgery using postoperative photographs and clinical examination notes, and scaling was made using the Whitaker classification. The evaluation showed that 85% of them were in class I, 11.6% were in class II, and 3.3% were in class III. No case was in class IV. Only the last 10 cases received the new surgical technique, and all were in class I. Complication rate was 38.3% for all cases and was only 20% for the last 10 cases, that is, the new technique group. Revision rate for trigonocephaly surgery was 13.3%, and the most common reason was hardware removal. None of the patients from the new technique group underwent revision surgery. We believe that our new technique is fast and easy, can provide sufficient bone graft, and is more useful for older patients (>1 y). Early postoperative results have been promising.
额缝早闭的特征为龙骨状前额（三角头畸形）、前额中线明显隆起、双侧颞部变窄、眶上缘双侧后缩、椭圆形眼眶、鼻背低平以及前颅窝容积减小。主要治疗方法是在12个月龄前进行早期手术干预，通常包括双额开颅术，同时进行双侧轮廓重塑、眶上缘外侧前移和外侧移位。在此，我们开发了一种新的简化技术用于三角头畸形的手术治疗。1995年1月至2010年1月期间，第一作者共对60例三角头畸形患者进行了手术。术后6个月，利用术后照片和临床检查记录对手术效果进行评估，并采用惠特克分类法进行分级。评估结果显示，其中85%为I级，11.6%为II级，3.3%为III级。无IV级病例。仅最后10例采用了新的手术技术，且均为I级。所有病例的并发症发生率为38.3%，而最后10例即新技术组的并发症发生率仅为20%。三角头畸形手术的翻修率为13.3%，最常见的原因是取出固定装置。新技术组的患者均未接受翻修手术。我们认为我们的新技术快速简便，能够提供足够的骨移植，并且对年龄较大的患者（>1岁）更有用。术后早期结果很有前景。
