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ISSN 2992-8559 (Electronic)
ISSN 1405-0625 (Print)

2015, Number 3

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Cir Plast 2015; 25 (3)

Trigonocephaly: functional surgical remodeling

Gordillo DLF, Andrade DL, Garza MS, Torres GS, Baca R, Gordillo ALF

Language: Spanish
References: 28
Page: 150-160
PDF size: 540.80 Kb.


ABSTRACT

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 is temporal emptying, the lack of defect correction, damage of unaffected sutures while making transpositions that produce defects in growth and cranial molding. In the period from 2010 to 2015, we operated on four patients with trigonocephaly in private hospitals. The age average was 3 months. They were studied with presurgical CBT-3D, electroencephalograms, neurodevelopmental assessment and ophthalmology. By means of a zigzag bicoronal incision the stenosed metopic suture was resected and frontal craniotomies in the form of beetle wing were carried 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. The functional and aesthetic results were excellent, without ossification defects or vacuum the temporal fossa, morbidity or mortality, with the scar hidden by hair. The children’s neuropsychological development had a noticeable improvement in irritability and activity and interaction with their parents. Surgery achieves total defect correction and in younger children a bone remodeling and harmonic skull growth is achieved by respecting the sutures system. Modifications to the technique avoid the temporary emptying defect.


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