Low-cost beetle-wing fronto-orbital advancement using nonabsorbable suture fixation for non-syndromic trigonocephaly: A single center experience.

BACKGROUND Trigonocephaly results from premature fusion of the metopic suture, leading to restricted frontal bone growth and a triangular forehead. Its incidence has increased, and fronto-orbital advancement (FOA) with frontal remodeling is now the standard surgical treatment, However, the use of absorbable fixation system may increase costs and limit accessibility. This study evaluates the aesthetic and functional outcomes of a modified Dhellemmes (Lille) beetle-wing FOA using nonabsorbable sutures as a low-cost alternative for nonsyndromic trigonocephaly.

METHODS Twenty-four patients aged 6-12 months with nonsyndromic trigonocephaly treated at the Hospital Universitario "Dr. José Eleuterio Gonzalez" between 2019 and 2022 were included. Parental satisfaction regarding aesthetic and functional outcomes was assessed through telephone interviews using a four-point scale (very satisfied: 4; satisfied: 3; slightly satisfied: 2; completely dissatisfied: 1).

RESULTS The study included 15 (62.5%) males and 9 (37.5%) females who underwent bettle-wing FOA at a mean age of 9.2 months. Postoperative evaluation using a structured parent-reported questionnaire demonstrated high aesthetic and functional satisfaction. A significant correlation was observed between aesthetic and functional outcomes (Spearman's ρ = 0.622 and 0.924, respectively; p = 0.05). No intraoperative or postoperative complications were reported.

CONCLUSIONS The modified surgical technique using nonabsorbable sutures such as Silk or 3-0 Prolene provides a safe, effective, and affordable alternative for the correction of trigonocephaly in infants. It yields aesthetic and functional outcomes while potentially lowering overall surgical costs, thereby improving accessibility in resource-limited settings.