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Childs Nerv Syst. 2012 Sep;28(9):1375-80. doi: 10.1007/s00381-012-1806-9. Epub 2012 Aug 8.

The Christmas tree foreheadplasty: a novel technique used in combination with a bandeau for fronto-orbital remodelling in craniosynostosis.

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The Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.



Craniosynostosis of the coronal, metopic and frontosphenoidal sutures results in deformity of the forehead. This may cause both functional and psychological difficulties for patient and parent. We describe a novel surgical technique, the 'Christmas tree foreheadplasty', used in combination with a supraorbital bandeau to achieve fronto-orbital remodelling.


Between November 2008 and September 2011, 32 patients with craniosynostosis underwent fronto-orbital remodelling with a supraorbital bandeau in combination with Christmas tree foreheadplasty. Indications for surgery, age at surgery, blood transfusion requirements, length of hospital stay and perioperative complications were assessed. A 'blinded', independent reviewer, age-matched controlled, panel photograph study was also undertaken to review results of the surgery. A parental satisfaction survey by telephone questionnaire was undertaken.


Mean age at surgery was 16 months. Average hospital stay was 3 days. Mean follow up time to this report was 19.5 months. Indications for the procedure included unicoronal, frontosphenoidal, metopic and bicoronal synostosis. Thirty of the 32 patients required a blood transfusion. One patient has required revision surgery following extrusion of prosthetic fixation plate. Surgical outcome measured by 'blinded' independent reviewers indicated that a significantly different preoperative score from normal was rendered to no significant difference from age-matched normal controls postoperatively. Parental satisfaction score of forehead appearance was significantly improved by the technique.


The Christmas tree foreheadplasty is a commendable and reproducible technique for forehead remodelling in combination with supraorbital bandeau and is now used more widely for forehead reconstruction for congenital cases.

[Indexed for MEDLINE]

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