Metopic triangle osteotomy in trigonocephaly Piezosurgery: a technical variant to control metopic emissary veins.

Pierre-Aurelien Beuriat,Federico Di Rocco,Christian Paulus,Alexandru Szathmari,Carmine Mottolese,Maria Licci,Arnaud Gleizal

doi:10.3171/2021.1.focvid20132

Pierre-Aurelien Beuriat, Federico Di Rocco + Show 5 more

Open Access

https://doi.org/10.3171/2021.1.focvid20132

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Abstract

Premature fusion of the metopic suture results in trigonocephaly with variable degrees of anterior cranial fossa dysmorphia and craniofacial deformity. Different surgical corrective techniques that aim to reshape the forehead and enlarge the cranial volume have been described. Typical variations of the standard fronto-orbitary advancement carry the risk of relevant blood loss during frontal osteotomy, where paired emissary metopic veins are disrupted. The authors present a technical variant that preserves a bony triangle over the glabella to optimize control of these veins, which represent the major source of bleeding, and applies Piezosurgery to perform the osteotomies to minimize bone substance loss.The video can be found here: https://vimeo.com/511536423.

Highlights

The authors present a metopic triangle osteotomy in trigonocephaly surgery—a technical variant to control metopic emissary veins
The perioperative morbidity of these surgical correction techniques is given by the risk of significant bleeding during osteotomies, due to the encasement of the superior sagittal sinus in the bone ridge and the presence of paired metopic transosseous emissary veins superior to the glabella that are associated with the fused metopic ridge.[7]
We present a technical variant of the frontal craniotomy that preserves a bony triangle over the glabella, preventing that the underlying veins are torn during elevation of the bony flap and resulting in optimized hemostatic control.[7]

Summary

Introduction

The authors present a metopic triangle osteotomy in trigonocephaly surgery—a technical variant to control metopic emissary veins. We present a technical variant of the frontal craniotomy that preserves a bony triangle over the glabella, preventing that the underlying veins are torn during elevation of the bony flap and resulting in optimized hemostatic control.[7] Piezosurgery is used to obtain precise cuts and minimize bone loss, which is important at the level of the fronto-orbital bandeau to optimize aesthetic outcome.

Results

Conclusion