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A new quantitative image-based method for evaluation of bony temporal hollowing in metopic synostosis

Journal article
Authors Linn Hagmarker
Madiha Bhatti Söfteland
Giovanni Maltese
Peter Tarnow
Emma Wikberg
Lars Kölby
Peter Bernhardt
Published in Journal of Plastic Surgery and Hand Surgery
Volume 50
Issue 6
Pages 343-348
ISSN 2000-656X
Publication year 2016
Published at Institute of Clinical Sciences, Department of Radiation Physics
Institute of Clinical Sciences, Department of Plastic Surgery
Pages 343-348
Language en
Keywords Metopic synostosis, temporal hollowing, computed tomography images, MATLAB, intracranial volume, surgical-treatment, craniosynostosis, complications, Orthopedics, Surgery
Subject categories Clinical Medicine


Objective: Premature craniosynostosis is a congenital disorder causing a skull deformity. For both functional and cosmetic reasons, the deformity is surgically treated with a cranioplasty before the age of 1 year. Temporal hollowing is a common and undesirable remaining deformity after cranioplasty for metopic synostosis. The most common method to determine the degree of temporal hollowing is subjective judgement of the temporal region. The aim of the present project was to develop a quantitative semi-automatic computer tool for objective measurement of bony temporal hollowing. Methods: Using MATLAB, a tool was developed to segment computed tomography images, defining the outermost contour. The images were dorsally limited to the widest point of the head. In each case, a sex-and age-matched control was identified and the contours compared. The bony temporal hollowing of the cases was calculated. Results: The intra-user coefficient of variation (CV) was 5.0% (95% CI = 4.2%-6.2%) and the inter-user CV was 3.0% (95% CI = 2.1%-8.6%). For clinical testing purposes, the tool was used in 14 patients, seven of whom had been operated on with a spring-assisted cranioplasty and seven with a cranioplasty using a bone graft. Conclusions: In summary, this study presents a new tool for objective measurement of the surgical result after cranioplasty for metopic synostosis.

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