An 18-month-old infant suffering from – Trigonocephaly, a rare condition in which the shape of the front of the head is triangular, causing aesthetic and neuropsychological development defects has been treated successfully by a team of doctors after a complex surgery of seven hours.

A multi-disciplinary team of doctors from Fortis Hospital Shalimar Bagh performed the surgery inform that a cranio-facial surgery requires meticulous planning. It is performed to correct the deformity.

Detailing about the surgery, Dr Sonal Gupta, Director, Neuro and Spine Surgery said, “The infant presented with a triangular-shaped appearance on the forehead and hypotelorism (a condition in which, the eyes appear closer together than normal). Normally, the bones forming the skull are separated by joints called sutures, which also serve as centres of growth. These sutures fuse at set times after birth, one of the earliest being the suture between frontal bones, the metopic suture which obliterates between 3-9 months of age. An early sutural fusion results in lack of skull growth in a direction perpendicular to the suture. However, the brain is still growing at a rapid rate during this period and needs space to do so. Therefore, the condition needed to be corrected, as it could hamper the neuro-psychological development of the child in addition to the obvious aesthetic defect.”

Elucidating about the 3D printing technology Dr Richie Gupta said, “A cranio-facial approach was needed to correct the deformity. We fed the digital data from the patient’s 3D CT scan into the 3D printer to print two rapid protype skull and upper face models, which were exact replicas of the patient’s skull. We worked on these to determine the exact size, dimensions, and angles of the osteotomies (bony cuts) on the patient’s skull. There was no scope for even the smallest of deviations as it could cause the child to go blind, bleed profusely or even suffer from brain damage. To ensure that the actual surgery went off smoothly, we conducted the mock surgery on the 3D model of the skull a day prior.”

She further added that during the actual surgery, they transferred the measurements from 3D models to the patient’s skull. Did an entire cranio-facial remodelling by removing the frontal bones (these form the forehead and front part of the skull), as well as the orbital bandeau (which forms the lower part of the forehead and the upper half of eyeball sockets) while simultaneously ensuring that the brain and eyeballs were protected.

“We recontoured these bones to the angles and dimensions as per the model surgery and replaced these in the corrected position. We used absorbable sutures, mini plates and screws to avoid migration of implants to intracranial or inaccessible locations with later growth of this child. Our work with the two 3D models proved to be fruitful, enabling us to be meticulous in our execution, reducing the operative time and allowing the actual surgery to be precise,” Gupta added.

Mentioning that it was a complex surgery which took seven hours, Sonal said, “To put an infant under anaesthesia for that long is a challenge. It was an intensive and precise process. There was a risk of significant blood loss during the surgery, so multiple blood products were arranged.”

Dr Mahipal Bhanot, Zonal Director, Fortis Hospital Shalimar Bagh said, “Multiple specialities worked together to ensure that the best possible patient care was provided to the patient.”

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