A simple technique for the correction of frontal bossing in synostotic scaphocephaly.

INTRODUCTION: Scaphocephaly may be accompanied by bossing of the frontal bones. In severe cases, this frontal deformation must be directly addressed during surgery. We describe a simple and effective surgical technique of reducing frontal bossing in scaphocephalic infants, avoiding the creation and transposition of free bone flaps. SURGICAL TECHNIQUE: After sagittal suturectomy and parietal barrel stave incisions, four (or five) lanceolate pieces of the frontal bone, extending in a radial orientation from the cranial base towards the fontanel, are excised, resulting in three (or four) vertical bone bridges. Small strips (rectangular to the apico-basal axis) are cut out from these bridges, leaving basal and apical bone tongues. The tabula externa at the base of the basal tongues is drilled off and the tongues are bent inward to correct the inferior aspect of the frontal bossing. Corresponding basal and apical bone tongues are then re-approached and fixated with sutures.
RESULTS: This results in an immediate cosmetic improvement. There are no transposition and re-insertion of free bone flaps necessary, as all bone elements stay attached to the basal or apical calvaria. Plate and screw fixation is not needed. PATIENTS AND METHODS: This procedure was applied in 15 scaphocephalic infants (<1-year old) with severe frontal bossing; it needed an additional 30 min operating time compared with suturectomy and barrel stave cuts alone.
CONCLUSION: The described technique is easy and fast and resulted in satisfactory cosmetic improvement in all patients. We recommend it for the correction of frontal bossing in scaphocephalic infants undergoing surgery in the first year of life.