Lastly, the frontal bone is divided into two, rotated and attached to the supraorbital bar causing a nude area (craniectomy) between the parietal bone and frontal bone. Bone will eventually regenerate since the dura mater lies underneath (the dura mater has osteogenic capabilities). This results in an advancement and straightening of the forehead. Floating forehead technique
The so-called floating forehead technique combined with the remodelling of the supraorbital bar is derived from the fronto-supraorbital advancement and remodelling. The supraorbital bar is remodelled as described above. The frontal bone is split in two pieces. Instead of using both pieces as in fronto-supraorbital advancement and remodelling, only one piece is rotated and attached to the supraorbital bar. This technique also leaves a craniectomy behind. Other
SuturectomyThe simplest form of surgery for trigonocephaly was suturectomy. However, as this technique was insufficient to correct the deformities, it is not used anymore. Distraction osteogenesisDistraction osteogenesis is based on creating more cranial space for the brain by gradually moving the bones apart. This can be achieved by using springs. Minimal invasive endoscopic surgeryThese approaches are 2D solutions for a 3D problem, therefore the results are not optimal. Distraction osteogenesis and minimal invasive endoscopic surgery are yet in experimental phase. Outcomes
Surgical
Trigonocephaly seems to be the most compliant form of craniosynostosis for surgery. Because of standardization of current surgical approaches there is no surgical mortality and complications are few to none. The simple suturectomy is presently insufficient to adjust the complicated growth restrictions caused by metopic synostosis.
Sudomotor dysfunction is one of the most common and earliest neurophysiological manifestations of small fiber neuropathies.In some instances, the small fibers of the autonomic nervous system can be affected, leading to urinary or bowel problems, episodes of rapid heartbeat (palpitations), dry eyes or mouth, or abnormal sweating. They can also experience a sharp drop in blood pressure upon standing (orthostatic hypotension), which can cause dizziness, blurred vision, or fainting. Small fiber neuropathy is considered a form of peripheral neuropathy because it affects the peripheral nervous system, which connects the brain and spinal cord to muscles and to cells that detect sensations such as touch, smell, and pain. Insensitivity to pain can be particularly problematic. One may be bleeding or have a skin injury without even knowing it. Topographic pattern
Like many polyneuropathies, the symptoms are typically length-dependent, starting in the longer nerves and progressively attacking shorter nerves. This means that symptoms often start in the hands and feet before progressing upwards, and that symptoms are usually more severe in the extremities. Some patients have a widespread, non-length dependent, or "patchy", presentation which is sporadic and can affect many nerves. Patients with Fabry disease have isolated small fiber engagement, and can have a more widespread small fiber disruption. Causes
Mutations in the SCN9A or SCN10A gene can cause small fiber neuropathy. These genes provide instructions for making pieces (the alpha subunits) of sodium channels.