Treatment of Nonsyndromic Bilateral Coronal Synostosis Using a Multiple Bone Flap Rotation-Reposition Technique

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Abstract
Brachycephaly is the result of premature fusion of the bilateral coronal suture. Various surgical procedures have been devised to manage brachycephaly, but there is no standard surgical method in brachycephalic treatment. Suboptimal results may be related to the tendency of misdirected bone growth of the remaining cranium in brachycephaly. Therefore, the abnormal growth vectors should be corrected toward a more normal configuration. Between 1997 and 2001, three nonsyndromic brachycephalic patients were treated using the described procedure. The cranial remodeling procedure used consists of supraorbital bar advancement and the rotation-reposition of multiple frontoparietal bone flaps. The frontoparietal bone was cut into seven segments consisting of two upper frontal, two lower frontal, one anterior parietal (T-shaped), and two posterior parietal segments. Each lower frontal segment was rotated 180° and transposed with the corresponding contralateral upper frontal segment. Each upper frontal segment was then transposed to the upper margin of the supraorbital bar. The posterior margin of the frontal segment was not fixed (floating forehead). Anterior parietal and two posterior parietal segments were trimmed and repositioned to the original position. The postoperative follow-up period ranged from 17 to 52 months (mean = 30 months). The cranial configuration obtained after the operation was considerably improved, approaching a normal shape in all cases. The mean length of frontal advancement was 11 mm (range: 7–15 mm). The preoperative mean value of the cephalic index was markedly raised to 104.7 (range: 100–111). The postoperative (at last follow-up) mean value of the cephalic index was 89.2 (range: 86.3–94.3). A better skull contour could be obtained easily by converting abnormally directed long upward and transverse dimensions to short anteroposteriorly directed dimensions. Cranial remodeling using repositioned multiple bone flaps can produce excellent results functionally and esthetically in brachycephaly.