Prevention of “Temporal Hollowing” After Fronto-orbital Advancement for Craniosynostosis

Persing, John A.; Mayer, Peter L.; Spinelli, Henry M.; Miller, Louis M.; Criscuolo, Gregory R.

doi:10.1097/00001665-199409000-00018

Cited by 45 publications

(30 citation statements)

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“…22,23,31 Although surgical procedures to correct unicoronal plagiocephaly have evolved significantly, postsurgical deformities (relapse) that warrant secondary corrective surgical revisions are still common. 10,28 Our proposed hypercorrection technique for unicoronal synostosis was not associated with a surgical relapse (Category IIB or above on the expanded Whitaker scale) that warranted a subsequent corrective reoperation (Fig. 2-4, Table 1).…”

Section: Discussionmentioning

confidence: 90%

“…3,28,31 The cause of the temporal hollowing remains a matter of debate. Multiple reports have suggested the role of temporal muscle atrophy, 31 temporal fat atrophy, 30 and type of surgical technique 12,15 in the causation of postsurgical temporal hollowing.…”

Section: 31mentioning

confidence: 99%

“…Multiple reports have suggested the role of temporal muscle atrophy, 31 temporal fat atrophy, 30 and type of surgical technique 12,15 in the causation of postsurgical temporal hollowing. Persing et al 28 described the temporalis musculo-osseous flap surgical technique as a method to prevent temporal hollowing after frontoorbital advancement in a patient with unicoronal plagiocephaly. However, because this report was based on a single case, it is difficult to assess the reliability of the technique.…”

Section: 31mentioning

confidence: 99%

“…22 One of the most common postsurgical deformities after unicoronal repair is ipsilateral temporal constriction. 28, 31 Hilling et al 12 published an article on a series of 53 patients who underwent unilateral coronal synostosis repair in which a bandeau advancement technique was used. Patients in whom this technique was used, however, commonly presented with residual postoperative temporal constriction.…”

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confidence: 99%

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Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique

Mesa¹,

Fang²,

Muraszko

et al. 2011

FOC

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Object Successful surgical repair of unicoronal plagiocephaly remains a challenge for craniofacial surgeons. Many of the surgical techniques directed at correcting the stigmata associated with this craniofacial deformity (for example, ipsilateral supraorbital rim elevation [vertical dystopia], ipsilateral temporal constriction, C-shaped deformity of the face, and so on) are not long lasting and often result in deficient correction and the need for secondary revision surgery. The authors posit that the cause of this relapse was intrinsic deficiencies of the current surgical techniques. The aim of this study was to determine if correction of unilateral coronal plagiocephaly with a novel hypercorrection surgical technique could prevent the relapse of the characteristics associated with unicoronal plagiocephaly. Methods The authors performed a retrospective analysis of 40 consecutive patients who underwent surgical repair of unicoronal plagiocephaly at their institution between 1999 and 2009. In all cases, the senior author (S.R.B.) used a hypercorrection technique for surgical reconstruction. Hypercorrection consisted of significant overcorrection of the affected ipsilateral frontal and anterior temporal areas in the sagittal and coronal planes. Demographic, perioperative, and follow-up data were collected for comparison. The postsurgical appearance of the forehead was documented clinically and photographically and then evaluated and scored by 2 independent graders using the expanded Whitaker scoring system. A relapse was defined as a recurrence of preoperative features that required secondary surgical correction. Results The mean age of the patients at the time of the operation was 13 months (range 8–28 months). The mean follow-up duration was 57 months (range 3 months to 9.8 years). The postsurgical hypercorrection appearance persisted on average 6–8 months but gradually dissipated and normalized. No patients exhibited a relapse of unicoronal plagiocephalic characteristics that required surgical correction. In all cases the aesthetic results were excellent. Only 3 patients required reoperation for the management of persistent calvarial bone defects (2 cases) and removal of a symptomatic granuloma (1 case). Conclusions Our study demonstrates that patients who undergo unicoronal plagiocephaly repair with a hypercorrection surgical technique avoid long-term relapse. Our results suggest that the surgical technique used in the correction of unilateral coronal synostosis is strongly associated with the prevention of postsurgical relapse and that the use of this novel method decreases the need for surgical revision.

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Section: Discussionmentioning

confidence: 90%

Section: 31mentioning

confidence: 99%

Section: 31mentioning

confidence: 99%

mentioning

confidence: 99%

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Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique

Mesa¹,

Fang²,

Muraszko

et al. 2011

FOC

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show abstract

“…They also had no major complications, performed no planned reoperations, and only one patient (5%) required unplanned reoperation (Sloan et al, 1997) Total reoperation (reoperative fronto-orbital remodelling and calvarial vault reshaping) was necessary in two patients (9%) of Cohen's Collective (Cohen et al, 1994). Bitemporal hollowing is common after surgical correction of metopic synostosis (Persing et al, 1994;Oh et al, 2006;van der Meulen et al, 2009). Hollowing is usually located just lateral and slightly cranial to the lateral apex of the eyebrow.…”

Section: Categorymentioning

confidence: 99%