Background and objective

The premature synostosis of the metopic suture in the most severe forms occurs with a restriction of the lateral growth of frontal and temporal bones, affecting the supraorbital rims, which limits its growth and leads to hypoteleorbitism. The triangular shape of the forehead is accentuated by the compensatory growth of the other structures of the skull. The main problem of the handling techniques are: temporal emptying, lack of defect correction, damage of unaffected sutures while making transpositions that will later produce defects in growth and cranial molding.

Our aim is to show our surgical experience operated with the variations of the open technique that was conceived by Dhellemmes in France.

Methods

Between 2010 and 2018 we operated 7 patients with trigonocephaly; patients´ average age was 7 months. They were studied with presurgical and post operatory CBT-3D, electroencephalograms, neurodevelopmental assessment and by Pediatry and Ophthalmology.

Stenosed metopic suture was resected and frontal craniotomies shaped like beetle wings were performed out without drying the coronal suture, securing them to the fronto-orbital bar with a discreet progress of the side edges. The medial osteotomy of the orbital toolbar was used to reshape it and correct its angulation fixing it with a bone graft and radiated parietal osteotomy to modify the restriction of frontoparietal growth.

Results

Functional and aesthetic results were excellent, without ossification defects or vacuum the temporal fossa, morbidity or mortality, with the scar hidden by hair. Children’s neuropsychological development had a noticeable improvement in irritability, activity and interaction with their rents.

Conclusions

In trigonocephaly, early surgery achieves total defect correction in a single procedure and a bone remodeling and harmonic skull growth by respecting the sutures system. Our modifications to the technique avoid the temporary emptying defect and don´t use osteosynthesis material.

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