Bennett Katelyn G, Liang Fan, Ranganathan Kavitha, Muraszko Karin M, Vercler Christian J, Buchman Steven R
Section of Plastic Surgery, Department of Surgery.
Department of Neurosurgery, University of Michigan, Ann Arbor, MI.
J Craniofac Surg. 2018 Jan;29(1):56-61. doi: 10.1097/SCS.0000000000004044.
A lasting correction of trigonocephaly is difficult to achieve, as a durable correction requires significant expansion to overcome galeal restriction and soft tissue recoil of the scalp. High rates of relapse have been reported throughout the literature. The specific aim of this study was to determine if the senior author's method of "hypercorrection" decreases relapse and the need for subsequent revisional surgery.
Patients who underwent operative correction of metopic craniosynostosis between 1988 and 2011 were reviewed. All patients underwent the "hypercorrection" technique performed by the senior author. Hypercorrection consisted of a fronto-orbital advancement of 2.5 to 3.5 cm and a concomitant hyperexpansion of bitemporal projection. Split cranial bone grafting ensured adequate coverage of the significantly expanded cranial vault. Only patients who had at least 5 years of follow-up were included for review of outcomes. Relapse was defined as recurrence of bitemporal constriction or lateral orbital retrusion, requiring surgical correction.
Fifty-eight patients met criteria. Mean age at the time of surgery was 11 months. Mean follow-up was 9.0 years. During this time, 2 patients exhibited relapse requiring camouflage procedures. Cranial bone defects were found in 4 patients (7%), 3 of whom underwent cranial bone grafting, while 1 underwent methylmethacrylate placement at an outside institution. One patient underwent fat grafting for areas of soft tissue irregularity. No patients exhibited persistent sequelae of hypercorrection significant enough to require repeat fronto-orbital advancement.
Surgical hypercorrection of trigonocephaly seems to minimize relapse and the need for revision in long-term follow-up and is therefore an important technique to consider.
三角头畸形的持久矫正很难实现，因为持久的矫正需要显著的扩张来克服帽状腱膜的限制和头皮的软组织回缩。文献报道的复发率很高。本研究的具体目的是确定资深作者的“过度矫正”方法是否能降低复发率以及后续翻修手术的必要性。
回顾了1988年至2011年间接受额缝早闭手术矫正的患者。所有患者均接受了资深作者实施的“过度矫正”技术。过度矫正包括2.5至3.5厘米的额眶前移以及同时进行的双侧颞部投影的过度扩张。劈开颅骨移植确保了对显著扩张的颅顶有足够的覆盖。仅纳入至少有5年随访的患者以评估结果。复发定义为双侧颞部缩窄或眶外侧后缩复发，需要手术矫正。
58例患者符合标准。手术时的平均年龄为11个月。平均随访时间为9.0年。在此期间，2例患者出现复发，需要进行掩饰手术。4例患者（7%）发现颅骨缺损，其中3例接受了颅骨移植，1例在外部机构接受了甲基丙烯酸甲酯植入。1例患者因软组织不规则区域接受了脂肪移植。没有患者出现足以需要重复额眶前移的过度矫正持续后遗症。
三角头畸形的手术过度矫正似乎能在长期随访中使复发率和翻修需求降至最低，因此是一项值得考虑的重要技术。
