P56. Long-term Outcomes of Two Fronto-orbital Advancement and Remodeling Techniques in Metopic Craniosynostosis: A 33-year Single-institution Experience

PURPOSE: To better expand the anterior cranial fossa and account for growth and relapse after traditional front-orbital advancement (FOA), an intentional “overcorrection” technique was adopted by our institution in 2012. This study compares the complications, revisions, and long-term aesthetic outcomes between the “traditional” FOA (T-FOA) and “overcorrection” FOA (O-FOA) approaches for isolated metopic craniosynostosis. METHODS: A retrospective review was performed of all children who underwent FOA for isolated metopic craniosynostosis from 1987 to 2020 at our institution. Patients with ≥4 years follow-up were included. RESULTS: Of the 270 patients who underwent surgical correction of isolated metopic synostosis, 165 (61.1%) patients met inclusion criteria (n=100 (60.6%) T-FOA and n=65 (39.4%) O-FOA). Mean age at surgery was 10.9±6.3 months with follow-up of 9.6±4.1 years. There were 15 (9.1%) surgical complications and 49 (29.7%) patients underwent at least one secondary surgery, more commonly in the T-FOA cohort (43.0% vs 9.2%, p<.001). Patients who underwent T-FOA had higher Whitaker scores (2.0±1.0 vs 1.5±0.8, p=.002) and were more likely to have palpable hardware (41.0% vs 24.6%, p=.031), palpable bony irregularities (64.0% vs 21.5%, p<.001), and lateral orbital retrusion (48.0% vs 12.3%, p<.001) compared to those with O-FOA. However, in subgroup analysis of patients ≥10 years old (n=81), aesthetic outcomes (Whitaker 1.7 vs 2.0, p=.341) and reoperation performed/recommended (54.6% vs 72.9%, p=.216) were comparable between the two cohorts. CONCLUSION: FOA with overcorrection provides a safe and effective way to achieve improved aesthetic outcomes in the intermediate term, but similarly demonstrates a worsening aesthetic outcome over time.