Correction of metopic synostosis utilizing an in situ bandeau approach

Abstract

Metopic craniosynostosis is a common growth disturbance in the infant cranium, second only to sagittal synostosis. Presenting symptoms are usually of a clinical nature and are defined by an angular forehead, retruded lateral brow, bitemporal narrowing, and a broad-based occiput. These changes create the pathognomonic trigonocephalic cranial shape. Aesthetic in nature, these morphological changes do not constitute the only developmental issues faced by children who present with this malady. Recent studies and anecdotal evidence have also demonstrated that children who present with metopic synostosis may face issues with respect to intellectual and/or psychological development. The authors present an elegant approach to the surgical reconstruction of the trigonocephalic cranium using an in situ bandeau approach.

Keywords: craniosynostosis; metopic; suture; trigonocephaly.

Fig. 1

Three-dimensional computed tomography, apical view, demonstrating the classic trigonocephalic shape of metopic synostosis. Note the anterior ridging indicative of early metopic closure.

Fig. 2

Planar computed tomography image demonstrating the triangular shape of the cranium.

Fig. 3

Three-dimensional computed tomography, frontal view. Note the bitemporal narrowing and the associated pinching of the lateral supraorbital brow. The orbits are elongated in the craniocaudal dimension.

Fig. 4

Intraoperative presentation of the skull from an apical view.

Fig. 5

Tessier bone benders applied to the in situ bandeau. Note the flattening of the central supraorbital bandeau and flaring of the lateral arms. The lateral arms will be bent back toward the cranium to create a more natural “sunglasses” shape.

Fig. 6

A rendering indicating the osteotomy lines that are created at the junction of the temporoparietal bone. These cuts allow the temporal bone to be rotated outward in an effort to meet the newly positioned arms of the bandeau.

Fig. 7

Pre- and postoperative vertex view; note the rounding of the forehead and the natural line of the temporal region.

Fig. 8

Pre- and postoperative frontal view; the midline ridge is gone, the forehead is rounded, and the temporal region is full.