Facial Changes After Early Treatment of Unilateral Coronal Synostosis Question the Necessity of Primary Nasal Osteotomy

Abstract

Facial symmetry was achieved in the patients with UCS who underwent surgery regardless of surgical approach evaluated here. Our data showed a significant improvement in nasal and orbital-globe deviation, leading us to question the necessity of primary nasal correction in these patients.

Strategies for the Optimal Individualized Surgical Management of Craniofacial Fibrous Dysplasia

“…We used standardized facial photographs (frontal, oblique, and lateral views) obtained by a single professional photographer in our professional studio with 3 flashes. 18,19 Preoperative (before any surgical intervention) and postoperative (12 months after the initial major craniofacial procedure and the final craniofacial procedure at follow-up visits) photographs of all patients were categorized based on a previously adopted 8 outcome rating scale. 20 The Whitaker 20 rating scale, which focused on the need for additional surgery, was defined as: category I, no refinements or surgical revisions considered advisable or necessary; category II, soft tissue or lesser bone contouring revision were advisable; category III, required a considerable amount of additional surgeries (procedures not as extensive as the original procedure); and category IV, major craniofacial procedure advisable, duplicating or exceeding the original procedure.…”

Staged Surgical Correction of Severe Panfacial and Transverse Nasal Root Asymmetry in Unicoronal Synostosis

“…The base of the nose is drawn towards the synostotic side, whereas the tip of the nose and maxilla are rotated towards the side of the unfused suture. 2 In the lower face, anteroposterior shortening of the ipsilateral mandibular ramus, and anterior displacement of the temporomandibular joint results in a mild Class III jaw relationship, often with chin point deviation towards the contralateral side. 2 In summary, the resultant facial scoliosis involves complex asymmetry in all facial thirds—retrusion and superior displacement of the ipsilateral upper third, advancement and downgrowth of the contralateral upper third, and rotation of the middle and lower thirds toward the nonfused side.…”

Diagnosis of infant synostotic and nonsynostotic cranial deformities: a review for pediatricians

“…The closure of a coronal suture is called anterior plagiocephaly,23 , 24 while the closure of two sutures is termed brachycephaly (commonly found in syndromic craniosynostosis) 68 It predominantly affects females (60%), with similar incidence on both sides.…”

“…, 24 Strabismus is a common finding (50-60% of cases) and is the result of morphological changes in the orbital roof and trochlea, altering the function of the superior oblique muscle 25. Elevation of the ipsilateral sphenoid wing can be seen in simple skull radiography and is recognized as the “harlequin orbit” (Fig.…”

“…We recommend the procedure between 6 and 9 months of age, when there is already sufficient bone maturity for remodeling. Basically, a front-orbital advancement associated with frontal remodeling is performed and releasing both coronal sutures 24. Further procedures might be necessary as fat injection in the craniofacial skeleton to decrease facial asymmetries and correction of eyelid ptosis.…”