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    Surgical Treatment of Trigonocephaly
    (Journal Neurological Sciences, 2011) Akan, Mithat; Avci, Gulden; Silav, Gokalp; Akoz, Tayfun; Elmaci, Ilhan
    Metopic synostosis is a relatively rare form of nonsyndromic synostosis. Premature closure of the metopic suture results in deformation of the anterior calvarium, in the phenotypic features of trigonocephaly Trigonocephalic deformities are recognized because of a pathognomic 'keel-shaped' deformity of the forehead with a prominent midline ridge, bilateral frontotemporal constriction with compensatory biparietal expansion, supraorbital and lateral orbital retrusion and hypotelorism. 1 This article presents a surgical technique used over 5 years to treat trigonocephalic children. Retrospective analyses were performed on 9 patients with metopic synostosis treated during 2005-2010. The study included reviews of preoperative and postoperative computed tomography scans, operative techniques, clinical outcomes and complications. Operative techniques included fronto-orbital bandeau tilting after expansion with a midline interpositional -bone graft, detriangulation of foreheads with an inward bending at lateral orbital wall, multiple zigzag osteotomy of frontal bone, barrel-stave osteotomy of parietal bone. The average age of the patients at time of surgery was 11 months. Interorbital distances widened from 18.8 mm to 20.9 mm, biocular distance widened from 67.56 mm to 74.39mm, interorbital distance widened from 13.44mm to 15.65mm, intertemporal distance widened from 58.22mm to 64.16mm. Mean follow-up was 34 months, and no neurological sequelae or other significant complications were encountered. Trigonocephaly requires surgical correction involving anterior two-thirds calvarial remodeling with fronto-orbital advancement and frontal-bone remodeling. The described operative approach minimizes bone defects by adopting multiple zigzag osteotomy of the frontal bone. This modality results in significant improvements in skull form and high patient/parent satisfaction.
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    The Surgical Treatment of Plagiocephaly
    (Turkish Neurosurgical Soc, 2011) Silav, Gokalp; Avci, Gulden; Akan, Mithat; Taylan, Gaye; Elmaci, Ilhan; Akoz, Tayfun
    AIM: Anterior plagiocephaly usually occurs with premature synostosis of the ipsilateral half of the coronal suture. The forehead is flattened on the affected side, with a backward and upward displacement of the affected orbit. The bulging of the calvaria may occur in the contralateral parietal area. MATERIAL and METHODS: This article presents the surgical techniques used over 7 years to treat plagiocephalic children. Eleven patients with unilateral coronal synostosis treated during 2003-2010 were analyzed retrospectively. The study included reviews of pre and postoperative computed tomography scans, operative techniques, clinical outcomes and complications. Unilateral orbital advancement with tongue in groove was performed in 5, and bilateral orbital advancement in 6 cases. Pre and postoperative anthropometric measurements were used to document the amount of advancement of the elevated and recessed orbita, and the amount of withdrawal of the contralateral side. RESULTS: The mean age of the patients at time of surgery was 11 months. The preoperative values of the orbital height and retrusion were 0.68 cm and 1.87 cm, respectively. They were recorded as -0.1cm and 0,63 cm, postoperatively. Mean follow-up was 36 months, neither neurological sequelae nor other significant complications were encountered. CONCLUSION: The surgical corrections have resulted in significant improvements in skull shape and high patient/parent satisfaction.