Improved Facial and Skull-base Symmetry Following Osteotomy and Distraction of Unilateral Coronal Synostosis

Abstract

Unilateral coronal synostosis (UCS) constitutes approximately 10% of all incidents of craniosynostosis and primarily causes ipsilateral retrusion and contralateral bulging of the forehead. 1 In addition, UCS can lead to complex secondary deformities that comprise facial asymmetries with deviation of the nose toward the affected side, orbit dystopia, zygomatic asymmetries, and possible effects involving dental occlusion. [2][3][4][5][6][7] The functional consequences of UCS can include strabismus, amblyopia, and astigmatism, Background: Unilateral coronal synostosis (UCS) results in a surgically demanding deformation, as the deformity is asymmetric in the calvaria but also presents with facial scoliosis and orbital dystopia. Traditional cranioplasties correct the forehead but have little effect on the face and orbits. In this article, the authors describe a consecutive series of patients operated on for UCS with osteotomy of the fused suture combined with distraction osteogenesis. Methods: Fourteen patients (mean age, 8.0 months; range, 4.3 to 16.6 months) were included in this study. The authors measured and compared the orbital dystopia angle, anterior cranial fossa deviation, and anterior cranial fossa cant between preoperative computed tomography results and those at distractor removal. Results: Blood loss was 6.1 mL/kg (range, 2.0 to 15.2 mL/kg), and length of stay was 4.4 days (range, 3.0 to 6.0 days). The authors observed significant improvements in the median orbital dystopia angle from 9.8 degrees (95% CI, 7.0 to 12.6 degrees) to 1.1 degrees (95% CI, −1.5 to 3.7 degrees) (P < 0.001), anterior cranial fossa deviation from 12.9 degrees (95% CI, 9.2 to 16.6 degrees) to 4.7 degrees (95% CI, 1.5 to 7.9 degrees) (P < 0.001), and anterior cranial fossa cant from 2.5 degrees (95% CI, 1.5 to 3.5 degrees) to 1.7 degrees (95% CI, 0.0 to 3.4 degrees) (P = 0.003). Conclusions: Osteotomy combined with a distractor for UCS straightened the face and relieved orbital dystopia by affecting the nose angle relative to the orbits, correcting the deviation of the cranial base in the anterior fossa, and lowering the orbit on the affected side. Furthermore, this technique demonstrated a favorable morbidity profile with low perioperative bleeding and a short inpatient period, suggesting its potential to improve the surgical treatment of UCS.

Spring-Assisted Surgery of Unilambdoid Craniosynostosis

“…The use of linear measurements in combination with GM and asymmetry analyses could potentially offer a more comprehensive view of ULS and the restorative impact of SAS. Another form of DO is the use of a distractor device, which requires manual manipulation and has successfully treated unicoronal synostosis 37 . However, a study comparing this method of DO to CVR when treating ULS demonstrated no significant differences regarding perioperative bleeding, operation time, or 90-day postoperative complications 38 .…”

Discussion: Improved Facial and Skull-Base Symmetry following Osteotomy and Distraction of Unilateral Coronal Synostosis

“…I n this study, Mellgren et al retrospectively evaluated 14 patients with isolated unilateral coronal synostosis (UCS) treated with fronto-orbital distraction (FOD). 1 They report operative details, including blood loss and length of stay, postoperative complications, and morphologic changes by comparing preoperative and end-consolidation computed tomographic imaging. Their data suggest improvements in orbital and anterior cranial base morphology following FOD.…”