PMC9479511_01
Frontal (a), side profile (b), bird's-eye view (c), and modified bird's-eye views (d) of the patient displaying a pointed and prominent menton, ridging of the supraorbital rims, mild metopic ridging, hypotelorism, and relative bitemporal narrowing.
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F1
Her craniofacial examination was remarkable for ridging along the metopic and left coronal sutures with bitemporal narrowing and mild trigonocephaly, a flat anterior fontanel, and prominent supraorbital ridges [Figure 1].
Posterior-anterior skull radiograph obtained at 7 weeks of age demonstrating metopic suture synostosis.
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F2
The skull radiograph skull radiograph identified metopic suture craniosynostosis [Figure 2].
Frontal (a) and bird's-eye (b) three-dimensional views, as well as an axial view (c) of a noncontrast computed tomography scan obtained at 7 months of age displaying metopic synostosis, mild hypotelorism, and mild bitemporal narrowing.
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F3
After evaluation at the Craniofacial Clinic at 7 months of life, a CT scan of the head revealed very mild hypotelorism, bitemporal narrowing, and prominent ridging with complete synostosis of the metopic suture [Figure 3].
Bird's-eye view of the patient after subperiosteal dissection and bilateral reflection of temporalis muscles (a). Bird's-eye view after reconstruction (b) and closure (c).
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F4
Next, an anteriorly based pericranial flap exposing the frontonasal suture and frontozygomatic sutures was dissected in the subperiosteal plane [Figure 4a]. Next, the frontal bones were osteotomized, applied, and fixated in position to match the preoperative plan [Figure 4b]. Primary closure was achieved [Figure 4c].
Right side profile view showing adequate wound healing at postoperative day 7.
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F5
Her scalp incision appeared well approximated with no signs of infection or dehiscence [Figure 5].
Right side profile view showing superficial wound breakdown along the scalp incision.
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F6
The patient presented 1 month later for follow-up and was noted to have a 2 cm x 2 cm area of ulcerated skin at the lateral aspect of the right scalp flap [Figure 6].