Classification and Management of Metopic Craniosynostosis. Issue 6 (September 2015)

• Record Type: Journal Article
• Authors: Yee, Sydney T.; Fearon, Jeffrey A.; Gosain, Arun K.; Timbang, Mary R.; Papay, Frank A.; Doumit, Gaby
• Is Part Of: Journal of craniofacial surgery. Volume 26:Issue 6(2015)
• Publication Date: 2015-09
• Subjects: Facial bones -- Surgery -- Periodicals; Skull -- Surgery -- Periodicals; Face -- Surgery -- Periodicals; Surgery, Plastic -- Periodicals; 617.52
• DOI: 10.1097/SCS.0000000000001866
• Languages: English
• ISSNs: 1049-2275

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background:</title> <p>In the craniofacial surgery literature, there is a wide disparity of opinions regarding the management of nonsyndromic metopic synostosis. With the lack of level I evidence to support a particular regimen, we aimed to elucidate the current state of practice among craniofacial surgeons with the hope of establishing a standard of care.</p> </sec> <sec> <title>Methods:</title> <p>A survey was sent to 102 craniofacial surgeons. The survey featured 2 parts: clinical scenarios and questions regarding the following: primary indication for surgery, preference of timing, and choice of operative intervention for patients presenting with nonsyndromic isolated metopic synostosis. Surgeons were also queried regarding preoperative, intraoperative, and postoperative protocols.</p> </sec> <sec> <title>Results:</title> <p>The total response rate was 72% (73/102) for the clinical scenarios and 63% (64/102) for the complete survey. There was a large discrepancy when classifying and managing mild metopic synostosis, with between 16% and 35% of surgeons electing to operate on a mild case. All surgeons agreed to operate on moderate and severe cases. For 95% of respondents, skull deformity was the primary indication for treatment of craniosynostosis. Open surgical management was most commonly performed at 6 months (29%) of age. Open frontal orbital advancement was the most commonly performed procedure in mild (27%), moderate (77%), and severe (89%) cases. Endoscopic approaches were more likely to be used in milder cases by 19% of surgeons.</p> </sec> <sec> <title>Conclusion:</title> <p>Our survey demonstrates that there is a wide disparity of opinion among craniofacial surgeons regarding the diagnosis and management of mild nonsyndromic metopic synostosis.</p> </sec> <sec> <title>Level of Evidence:</title> <p>Diagnostic, level 5.</p> </sec> </abstract>