Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Spontaneous Forehead Remodeling After Posterior Vault Reconstruction in Sagittal Synostosis
Jose A. Gonzalez, B.S., Olivia E. Linden, B.A., Margaret E. Byrne, R.N., Petra M. Klinge, M.D., Ph.D., Stephen R. Sullivan, M.D., M.P.H., Helena O. Taylor, M.D., Ph.D..
Brown University - Alpert Medical School, Providence, RI, USA.

PURPOSE:
Surgeons advocate various methods to correct scaphocephaly secondary to sagittal synostosis, but little quantitative data exists to support one technique over another. One approach uses parietal and posterior vault reconstruction, which relies on post surgical forehead remodeling. The degree of indirect forehead remodeling following this approach remains unknown. We utilize three dimensional (3D) photogrammetry to measure the degree of spontaneous forehead remodeling following posterior vault reconstructions. We hypothesize that 1) spontaneous forehead remodeling occurs when the parietal and occipital cranium is reconstructed 2) this remodeling results in a normal forehead shape.
METHODS:
After IRB approval we used 3D photogrammetry to image children with sagittal synostosis undergoing posterior vault reconstructions, and age-matched controls. We measured the frontal bossing (FB) angle pre- and postoperatively, as well as in controls, and assessed differences through Welch’s t-test. Root mean square deviation (RMSD) values and color maps were generated to evaluate areas and degree of forehead remodeling over time. One-way MANOVA analysis tested for statistical differences in 3D forehead shape between groups utilizing a comparison of 44 forehead surface landmarks (Figure 1).
RESULTS:
We collected data on seven subjects (mean follow-up age of 16 months), and five age-matched controls. Preoperatively, children with sagittal synostosis had a mean FB angle of 109.5° ± 0.4° which decreased towards control values (102.3° ± 2.3°) at a mean follow-up of 10 months (106.5° ± 0.7°, p< 0.01) (Figure 2). Comparing pre- and postoperative forehead surfaces resulted in an average RMSD change of 0.67mm ± 0.17mm. RMSD changes were seen as early as 1 week and up to 2 years after surgery. RMSD color mapping demonstrated decreased bossing above the orbital rims, with minimal midsagittal change (Figure 3). MANOVA analysis showed statistically significant differences between pre- and postoperative forehead shape, satisfying hypothesis one (Pillais’ Trace = 1.000, observed power = 1.000, p < 0.01). Differences between postoperative and control shapes were not statistically significant, satisfying hypothesis two (Pillais’ Trace = 0.924, observed power = 0.145, p >0.05).
CONCLUSION:
3D photogrammetry can quantitatively assess forehead shape over time after posterior vault reconstruction for sagittal synostosis. Patients with sagittal synostosis and a posterior approach to reconstruction had spontaneous forehead remodeling and improvement in FB angle toward control measurements, without performing forehead craniectomy and reconstruction. Surface changes, measured by RMSD, increased over time and continued 2 years post-operatively. Patients had a statistically different mean forehead shape after surgery, which approximated that of age-matched controls. This data suggests that the forehead spontaneously remodels after a posterior approach to scaphocephaly, and that removal and reconstruction of the forehead is unnecessary.



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