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Metopic Craniosynostosis Versus Benign Metopic Ridging: Diagnostic And Management Trends Over A 15 Year Period
Fady P. Marji, Lisa Block, MD, Erin Anstadt, MD, Jesse Goldstein, MD, Joseph Losee.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Purpose:
The premature closure of the metopic suture may cause benign metopic ridging (BMR) or lead to trigonocephaly requiring frontal orbital advancement (FOA). The aim of this study was to investigate the demographic and peri-operative characteristics of patients surgically treated for true metopic craniosynostosis and evaluate changes in incidence of disease.

Methods:
A retrospective chart review was conducted on all patients evaluated at Children's Hospital of Pittsburg from 2003 to 2018 for BMR or metopic craniosynostosis. Demographic, peri-operative, and outcomes data was collected. Significance was ascertained by t test.

Results:
From 2003 to 2018, 84 patients were diagnosed with BMR and 95 patients were diagnosed with metopic craniosynostosis. Of the 95 patients with metopic craniosynostosis, 63 patients underwent FOA, 23 patients were managed non-operatively due to mild disease, 2 patient families refused surgery, 5 patients were lost to follow up, and 2 patients are awaiting operative intervention. Of patients undergoing surgery, mean age at diagnosis was 5.81 months (6.49 months), 69.84% of patients were males (n = 44), 88.89% of patients were white, and 57.47% were from multiparous mothers. 45.24% of patients undergoing FOA were found to have a submucous cleft palate, and 48.78% had deformational plagiocephaly. Mean age at intervention was 13.66 months ( 6.28 months), at a mean weight of 10.42 kg ( 2.10 kg). One patient was found to have elevated intracranial pressure. Mean estimated blood loss was 302.37 mL (163.63), mean blood salvaged was 59.23 mL (47.65), and mean blood transfused was 24.56 mL/kg (10.41). 3 patients required post-operative blood transfusion. There were 5 total dural lacerations requiring repair with no subsequent evidence of CSF leak. There was one major complication of hypoglobus of the left eye requiring take back to the operating room for examination, with no evidence of extraocular muscle entrapment found. Mean time spent in ICU was 1.20 days (0.76 days), and mean length of hospital stay was 4.0 days (1.49 days). Mean total length of follow-up was 3.49 years (3.31 years). At follow-up, 19% of patients were found to have supraorbital retrusion, 14% with temporal hollowing, and 15.87% with persistent calvarial defects. There was a statistically significant increase in the number of patients seen for BMR from 2011 to 2018 relative to 2003 to 2010 (p=0.00004) as well as number of patients undergoing FOA for metopic craniosynostosis (p=0.041).

Conclusions:
Premature metopic suture fusion manifests with phenotypic variation. There appears to be an association of SMCP and deformational plagiocephaly with metopic craniosynostosis. The treatment of trigonocephaly with FOA is associated with a low complication rate. There has been an increase in the number of patients seen for BMR and treated for metopic craniosynostosis over the study period.


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