Pang Dachling, Zovickian John, Wong Sui-to, Hou Yong Jin, Le Hop N
Paediatric Neurosurgery, University of California Davis, 2315 Stockton Blvd, Sacramento, CA, USA,
Childs Nerv Syst. 2013 Dec;29(12):2171-82. doi: 10.1007/s00381-013-2242-1. Epub 2013 Aug 1.
This study aims to describe a new procedure for the treatment of metopic synostosis and other frontal skull deformities.
The procedure comprises a supraorbital bandeau widened with an interpositional graft and rounded laterally to eliminate the acute angle, and parallel angulated slat cuts in the frontal bones. Greenstick fracturing of the medial bases of these slats along a parasagittal hinge line causes fanning of the slats and expansion of the frontal flap both anteriorly and laterally making the forehead contour wider and more rounded. We performed this procedure on six infants (four with severe trigonocephaly from metopic synostosis, one with brachycephaly from bicoronal synostosis, and one with multiple suture synostosis and parietal flattening) for whom only the angulated slat cuts (without bandeau) were used. Each patient had preoperative three-dimensional computed tomography (3D-CT) and postoperative 3D-CT at 1 week, 3 months, and 12 months, to follow the result.
The cosmetic improvements are dramatic in eliminating the midfrontal keel, hypotelorism, frontal-lateral retrusion, and temporal hollowing seen in severe metopic synostosis. In coronal synostosis, the procedure corrects the brachycephaly and gives a balanced, well-rounded frontal contour. The end results of the fronto-orbital correction resemble the ribbed dome of a cathedral; hence, the moniker the "cathedral dome procedure". No patient needed a second procedure to fill in cranial defects or recorrect deficient areas.
The parallel angulated frontal slat cuts technique (the "cathedral dome procedure") is a straightforward and easily mastered method that reliably produces excellent result for the correction of trigonocephaly and other frontal skull deformities.
本研究旨在描述一种治疗额缝早闭及其他额颅骨畸形的新方法。
该方法包括用植入物加宽眶上带并使其外侧圆润以消除锐角，以及在额骨上进行平行成角的板条切割。沿着矢状旁铰链线对这些板条的内侧基部进行青枝骨折，会使板条展开，额部皮瓣向前和向外侧扩展，使前额轮廓更宽且更圆润。我们对6名婴儿实施了该手术（4名因额缝早闭导致严重三角头畸形，1名因双冠状缝早闭导致短头畸形，1名因多条缝早闭和顶骨扁平），这些婴儿仅采用了成角板条切割（无眶上带）。每位患者术前均进行三维计算机断层扫描（3D - CT），术后分别在1周、3个月和12个月进行3D - CT，以追踪结果。
在消除严重额缝早闭中出现的额中部嵴、眶距过窄、额外侧后缩和颞部凹陷方面，美容效果显著。在冠状缝早闭中，该手术可纠正短头畸形，并给出平衡、圆润的额部轮廓。额眶矫正的最终结果类似于大教堂的肋状穹顶；因此，该方法被称为“大教堂穹顶手术”。没有患者需要二次手术来填补颅骨缺损或重新矫正缺陷区域。
平行成角额板条切割技术（“大教堂穹顶手术”）是一种简单且易于掌握的方法，能可靠地为三角头畸形及其他额颅骨畸形的矫正带来极佳效果。
