Comparison of Craniofacial Morphology Following Single- Versus Multi-Segment Fronto-Orbital Advancement for Metopic Synostosis

Objective Metopic synostosis (MS) is commonly corrected using multi-segment fronto-orbital advancement (FOA), including the frontal bone and supraorbital bandeau. Although this technique reliably expands the anterior vault, it is associated with contour irregularities and bandeau step-offs. The single-segment FOA, utilizing a unified parietal bone flap, was developed with the goal of restoring a seamless frontal contour. This study compares morphologic outcomes between single-segment and multi-segment FOA in MS. Design A retrospective review of 3-dimensional imaging of patients with MS who underwent single-segment or multi-segment FOA. Setting Tertiary pediatric institution. Patients, Participants Twenty patients with MS were included (10 single-segment, 10 multi-segment). Ten control patients were included at each time point for comparison. Interventions Single-segment or multi-segment FOA Main Outcome Measure(s) Pre- and 2-week, 1-year, and 2-year postoperative imaging were analyzed to assess craniometric variables and intracranial volumes. Craniofacial composites were created. Results Single-segment FOA demonstrated significantly shorter operative time ( P = 0.003) and reduced blood loss ( P = 0.008). Both groups achieved comparable increases in total (13-15%) and anterior cranial volume (23-28%) postoperatively. Craniometric analysis revealed equivalent improvement in orbital morphology. The interfrontal angle normalized to control levels in the single-segment group but remained significantly different in the multi-segment cohort through 2 years. Conclusions Single-segment FOA provides cranial and orbital morphologic correction equivalent to multi-segment FOA while reducing perioperative burden and limiting osteotomies across the frontal contour. This technique offers an efficient and reliable alternative for appropriately selected patients with MS.