A SURGICAL TECHNIQUE FOR THE TREATMENT OF TRIGONOCEPHALY: EVALUATION OF 11 PATIENTS

Abstract

The patients with trigonocephaly need to be operated for aesthetic and functional reasons such as normalization of their apperience and prevention from increased intracranial pressure. The purpose of this study is to define the surgical method that we use for reshaping of the fronto-orbital region in patients with trigonocephaly and evaluate the results of this treatment. All of the 11 patients with trigonocephaly (aged 7-18 months, mean=13.2) that were operated by the clinics of plastic surgery and neurosurgery between the years 1998 and 2006 were included in the study. The surgery consisted of removal of the frontal bone and the supraorbital bar, reshaping them, placement of the reshaped bony parts at advanced position, and fixation using wires and non-absorbable suture material. All patients were evaluated with physical and neurological examination, and photographs were taken both preoperatively and during the follow up period (1-7years, mean=2.4). A preoperative 3D-CT was performed in every patient. The aesthetic result was evaluated as very good if no sign of the abnormality or of the operation other than the incisional scar was visible, as good if only a minor depression in the temporal regions was visible, as fair if an obvious depression was seen in the temporal regions, and bad if there was obvious asymmetry or any sign of the original deformity suggesting insufficient correction or relaps. There were not any complications in any case other than an exposed fixation wire in one patient, which needed removal. Aesthetic result was very good in 5 patiens, good in 5, and fair in one. All patients continued to do well both in physically and neurologically. The very good and good results obtained in the majority of the patients, and the absence of any significant complications or any signs of relapsing deformity observed during the follow up period demontrated that the surgical method that we used was effecient and safe. Some details in the surgery such as the zigzag skin incision and the creation of a bony triangle at the end of the supraorbital bar, which fasciliated fixation, contrubuted to our good results. In some patients with severe anomalies however, insufficient widening of the narrow temporal region prevented us from obtaining a perfect appearing result. The surgical technique that we used in the treatment of patients with trigonocephaly was found to be safe and effective in obtaining good aesthetic results.