Alder Hey Children's Hospital, Eaton Road, Liverpool, United Kingdom.
J Craniofac Surg. 2021 Sep 1;32(6):2123-2128. doi: 10.1097/SCS.0000000000007475.
Isolated metopic synostosis presents with a range of severity, from a palpable ridge as the sole presenting feature to a constellation of features resulting in trigonocephaly. At our unit, patients on the moderate to severe end of the phenotypic spectrum of trigonocephaly are offered fronto-orbital advancement and remodeling. The authors present our series of trigonocephaly patients who have undergone surgical correction. From January 2000 to January 2020, the authors operated on 231 patients with trigonocephaly. The average age at surgery was 18 months, with an average follow-up of 77.4 months. Seventy-nine percent of patients had no comorbidity. Ten percent of patients sustained a dural tear with no long-term consequences. The total early complication rate was 12.1%. The most common early complications were wound infection and wound dehiscence at 7.4% and 3.9% respectively. The total reoperation rate was 6.5%. The introduction of infection prevention and control measures over the 2 decades at our unit reduced the reoperation rate to 1.1%. The most common late complication was temporal recession in 20.8% of patients, none of whom required aesthetic correction. The recurrence rate of a metopic ridge was 2.3% with no patients requiring further surgery. None of our patients required calvarial remodeling for raised intracranial pressure after the primary fronto-orbital advancement and remodeling. There were no life-threatening complications or mortalities in our cohort. The authors present recommendations which include an infection control care bundle, cessation of surgical drains, and practice adjustments to reduce risks of infection and risk of requiring further calvarial remodelling for raised intracranial pressure.
单纯性额缝早闭的严重程度不一，从仅表现为可触及的隆起到一系列导致三角头畸形的特征都有。在我们的单位，中重度三角头畸形患者可接受额眶前移和重塑。作者介绍了接受手术矫正的三角头畸形患者系列。2000 年 1 月至 2020 年 1 月，作者对 231 例三角头畸形患者进行了手术。手术时的平均年龄为 18 个月，平均随访 77.4 个月。79%的患者无合并症。10%的患者发生硬脑膜撕裂，但无长期后果。总的早期并发症发生率为 12.1%。最常见的早期并发症是伤口感染和伤口裂开，分别为 7.4%和 3.9%。总的再次手术率为 6.5%。在作者所在单位的 20 年中，引入感染预防和控制措施后，再次手术率降低至 1.1%。最常见的晚期并发症是颞部退缩，占 20.8%，但均无需美容矫正。额骨嵴复发率为 2.3%，无患者需要进一步手术。我们的患者中无一例因颅内压升高需要进行颅骨重塑。在原发性额眶前移和重塑后，我们的患者无一例因颅内压升高需要进行颅骨重塑。在我们的患者中，无危及生命的并发症或死亡。作者提出了一些建议，包括感染控制护理包、停止使用引流管，以及调整手术操作，以降低感染风险和因颅内压升高需要进一步颅骨重塑的风险。
