Abstract
Trigonocephaly in patients with metopic synostosis is corrected by fronto-orbital remodelling (FOR). The aim of this study was to quantitatively assess aesthetic outcomes of FOR by capturing 3D forehead scans of metopic patients pre- and post-operatively and comparing them with controls. Ten single-suture metopic patients undergoing FOR and 15 age-matched non-craniosynostotic controls were recruited at Great Ormond Street Hospital for Children (UK). Scans were acquired with a three-dimensional (3D) handheld camera and post-processed combining 3D imaging software. 3D scans were first used for cephalometric measurements. Statistical shape modelling was then used to compute the 3D mean head shapes of the three groups (FOR pre-op, post-op and controls). Head shape variations were described via principal component analysis (PCA). Cephalometric measurements showed that FOR significantly increased the forehead volume and improved trigonocephaly. This improvement was supported visually by pre- and post-operative computed mean 3D shapes and numerically by PCA (p < 0.001). Compared with controls, post-operative scans showed flatter foreheads (p < 0.001). In conclusion, 3D scanning followed by 3D statistical shape modelling enabled the 3D comparison of forehead shapes of metopic patients and non-craniosynostotic controls, and demonstrated that the adopted FOR technique was successful in correcting bitemporal narrowing but overcorrected the rounding of the forehead.
Highlights
Craniosynostosis is a condition in which one or more cranial sutures fuse prematurely, leading to an abnormal head shape
The main novelty of this study lies in the use of a statistical shape modelling (SSM) technique to characterise the “average” effects of surgery in our cohort by comparing mean 3D forehead shapes of pre-operative, post-operative and control scans (Figs. 5 and 6) and performing principal component analysis (PCA) to describe and quantify 3D head shape variability (Fig. 7)
Rigorous registration protocol allowed the calculation of surface distance maps that intuitively quantify and visualise 3D shape changes induced by surgery as well as shape differences between metopic and non-craniosynostotic forehead shapes (Fig. 6)
Summary
Craniosynostosis is a condition in which one or more cranial sutures fuse prematurely, leading to an abnormal head shape. Premature fusion of the metopic suture leads to bitemporal narrowing with a compensatory increase in cephalic width, resulting in trigonocephaly. The surgical procedure used to correct trigonocephaly in single-suture metopic synostosis at Great Ormond Street Hospital for Children (GOSH, London, UK) is fronto-orbital remodelling (FOR) (James et al, 2015). N. Rodriguez-Florez et al / Journal of Cranio-Maxillo-Facial Surgery 45 (2017) 387e394 in infants, in addition to the routine use of general anaesthesia for many of these scans, our group has not used routine CT scanning (either pre- or post-operatively) for uncomplicated single-suture synostosis cases for more than a decade (Cerovac et al, 2002). Other groups have reported that the routine use of CT in metopic synostosis is non-contributory (Engel et al, 2012)
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