Step Expansion of the Frontal Bar

In severe trigonocephaly, metopic suture synostosis extends inferiorly to involve the frontoethmoid suture, resulting in orbital hypotelorism. To correct this growth disturbance, a nasofrontal osteotomy with bone graft interposition has been advocated. We describe an alternative procedure, supraorbital bar step expansion, which does not require a bone graft or metallic miniplate fixation. The supraorbital bar step expansion avoids donor site morbidity and the potential for plate migration. This procedure not only corrects orbital distopia, but also improves the anterolateral position of the brows, lateral canthus, and temporal regions.