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Objective Assessment of the Interfrontal Angle for Severity Grading and Operative Decision-Making in Metopic Synostosis.

Publication ,  Journal Article
Anolik, RA; Allori, AC; Pourtaheri, N; Rogers, GF; Marcus, JR
Published in: Plast Reconstr Surg
May 2016

BACKGROUND: The purpose of this study was to evaluate the utility of a previously validated interfrontal angle for classification of severity of metopic synostosis and as an aid to operative decision-making. METHODS: An expert panel was asked to study 30 cases ranging from minor to severe metopic synostosis. Based on computed tomographic images of the skull and clinical photographs, they classified the severity of trigonocephaly (1 = normal, 2 = mild, 3 = moderate, and 4 = severe) and management (0 = nonoperative and 1 = operative). The severity scores and management reported by experts were then pooled and matched with the interfrontal angle computed from each respective computed tomographic scan. A threshold was identified at which most experts agree on operative management. RESULTS: Expert severity scores were higher for more acute interfrontal angles. There was a high concordance at the extremes of classifications, severe (4) and normal (1) (p < 0.0001); however, between interfrontal angles of 114.3 and 136.1 degrees, there exists a "gray zone," with severe discordance in expert rankings. An operative threshold of 118.2 degrees was identified, with the interfrontal angle able to predict the expert panel's decision to proceed with surgery 87.6 percent of the time. CONCLUSIONS: The interfrontal angle has been previously validated as a simple, accurate, and reproducible means for diagnosing trigonocephaly, but must be obtained from computed tomographic data. In this article, the authors demonstrate that the interfrontal angle can be used to further characterize the severity of trigonocephaly. It also correlated with expert decision-making for operative versus nonoperative management. This tool may be used as an adjunct to clinical decision-making when the decision to proceed with surgery may not be straightforward. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, V.

Duke Scholars

Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

May 2016

Volume

137

Issue

5

Start / End Page

1548 / 1555

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Surgery
  • Severity of Illness Index
  • ROC Curve
  • Infant
  • Humans
  • Frontal Bone
  • Delphi Technique
  • Craniosynostoses
  • Clinical Decision-Making
 

Citation

APA
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ICMJE
MLA
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Anolik, R. A., Allori, A. C., Pourtaheri, N., Rogers, G. F., & Marcus, J. R. (2016). Objective Assessment of the Interfrontal Angle for Severity Grading and Operative Decision-Making in Metopic Synostosis. Plast Reconstr Surg, 137(5), 1548–1555. https://doi.org/10.1097/PRS.0000000000002052
Anolik, Rachel A., Alexander C. Allori, Navid Pourtaheri, Gary F. Rogers, and Jeffrey R. Marcus. “Objective Assessment of the Interfrontal Angle for Severity Grading and Operative Decision-Making in Metopic Synostosis.Plast Reconstr Surg 137, no. 5 (May 2016): 1548–55. https://doi.org/10.1097/PRS.0000000000002052.
Anolik RA, Allori AC, Pourtaheri N, Rogers GF, Marcus JR. Objective Assessment of the Interfrontal Angle for Severity Grading and Operative Decision-Making in Metopic Synostosis. Plast Reconstr Surg. 2016 May;137(5):1548–55.
Anolik, Rachel A., et al. “Objective Assessment of the Interfrontal Angle for Severity Grading and Operative Decision-Making in Metopic Synostosis.Plast Reconstr Surg, vol. 137, no. 5, May 2016, pp. 1548–55. Pubmed, doi:10.1097/PRS.0000000000002052.
Anolik RA, Allori AC, Pourtaheri N, Rogers GF, Marcus JR. Objective Assessment of the Interfrontal Angle for Severity Grading and Operative Decision-Making in Metopic Synostosis. Plast Reconstr Surg. 2016 May;137(5):1548–1555.

Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

May 2016

Volume

137

Issue

5

Start / End Page

1548 / 1555

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Surgery
  • Severity of Illness Index
  • ROC Curve
  • Infant
  • Humans
  • Frontal Bone
  • Delphi Technique
  • Craniosynostoses
  • Clinical Decision-Making