Background/Purpose: Fronto-orbital advancement is an effective method of expanding intracranial volume and improving forehead contour in patients with metopic or coronal synostosis. This procedure results in significant periorbital swelling and often requires protracted post-operative hospitalization. The purpose of this study was to determine if perioperative corticosteroid diminishes post-operative swelling and, thus, reduces hospitalization, need for post-operative intubation, and intensive care unit stay following fronto-orbital advancment.
Patients/Methods: We conducted a retrospective study of consecutive children who underwent primary fronto-orbital advancement between 1990-2008. Patients were categorized into two groups: Group I was not given perioperative corticosteroid, whereas Group II received intra-operative dexamethasone that was tapered post-operatively. Primary outcome variables included length of hospital stay, requirement for post-operative intubation, duration of intensive care unit stay, infection rate and cost of post-operative hospitalization.
Results: The study included 161 children: Group I = 96 and Group II = 65. Fronto-orbital advancement was performed at an average age of 10.5 months (range, 3.5 to 23 months). The median hospital stay for dexamethasone treated children in Group I was 5.0 days (inter-quartile range 4.0, 5.0), compared to 3.0 days (inter-quartile range 3.0, 4.0)  for untreated children in Group II (p= 0.008). Thirty-three children in Group I (34.4%) remained intubated at the completion of the procedure due to airway edema compared to only 7 patients in Group II (10.8%) (p=0.4). Twenty-five children in Group I (26.3%) required more than a 24 hour intensive care unit compared to 12 patients in Group II (18.5%) (p=0.6). Two patients in Group I (2.1%) and 1 patient in Group II (1.5%) developed a surgical site infection, and this difference was not significant (p= 0.8). Mean cost of post-operative hospitalization for Group I (5 days) was $16,076.00, 27.2% more than Group II (3 days) $11,700.00. Conclusion: Perioperative corticosteroid shortened hospitalization following fronto-orbital advancement without increasing the incidence of post-operative infection. Reduction in hospital stay decreased post-operative costs by 27.2%. While patients receiving corticosteroid had a shorter post-operative intubation time and intensive care unit stay, the effect was not large enough to show a significant difference independent of the effects of surgeon or operative time.