Prospective Anthropometric Analysis of Sagittal Orbital-Globe Relationship following Fronto-orbital Advancement in Childhood

Abstract

Fronto-orbital advancement is a common procedure for correction of supraorbital retrusion in patients with coronal craniosynostosis. The aim of this study was two-fold: to quantitate change in the sagittal orbital-globe relationship following fronto-orbital advancement in childhood and to determine the ratio of skeletal-to-soft tissue movement. Soft-tissue points on the orbital rim, orbitale superius (os), orbitale laterale (ol), orbitale inferius (oi), and nasion (n), referenced to apex corneae (ac), were measured preoperatively and postoperatively by a custom-made anthropometer. Intraoperative bony advancement was measured with a caliper. Patients were selected with uniform advancement at the fronto-nasal suture and laterally at the mortise and tenon. Fifteen patients with syndromic craniosynostosis were included in the study (six male, nine female): Apert (n = 2), Crouzon (n = 5), Pfeiffer (n = 4), Saethre-Chotzen (n = 3), and Boston type (n = 1). Average age at operation was 8.7 years (range, 4.5 to 10.5 years). Age, sex, method of fixation, postoperative interval, diagnosis, and skeletal movement were analyzed for possible effect on the magnitude of soft-tissue advancement. Average intraoperative skeletal advancement was 12.1 mm, and average postoperative soft-tissue movement was 10.3 mm (p < 0.001), measured at the midpoint of the supraorbital rims (os). The soft tissue: skeletal movement ratio was 0.9:1. Os was the only point at which soft-tissue advancement could be predicted (Spearman's rank correlation coefficient = 0.67); soft-tissue changes at ol, oi, and n were unpredictable. Skeletal movement was the only determinant of soft-tissue advancement of all variables tested, i.e., diagnosis, age, sex, previous fronto-orbital advancement, and wire versus plate fixation. We make recommendations for calculating the magnitude of fronto-orbital advancement, based on preoperative anthropometry and a soft-to-hard tissue advancement factor.

Orbital Volume and Surface After Le Fort III Advancement in Syndromic Craniosynostosis

“…11,12 In this study, the orbit was studied as the intraorbital volume that is the volume of the orbital content and not the volume of the bony orbit, because of the biases that could be created by preoperative and postoperative remodeling and segmentation. A statistically significant increase in the orbital volume and in the orbital surface after Le Fort midface advancement was observed.…”

Isolated frontosphenoidal synostosis: a rare cause of synostotic frontal plagiocephaly

“…The concept of the sagittal orbital-globe relationship, promulgated by Mulliken and coworkers in 1996, defines the sagittal distance between the superior orbital rim (orbitale superior) and the anterior cornea and is one of the most powerful clinical tools to identify (or rule out) fusions in the coronal ring. 9,10 Because the coronal ring sutures are responsible for anterior growth of the forehead and bandeau, synostosis of any of these elements will restrict sagittal growth and produce a negative relationship (that is, the superior orbital rim lies posterior to the anterior cornea). A negative superior orbital rim-anterior cornea relationship is ubiquitous in patients with UCS and was observed in all of our patients with IFS.…”

Identical Twins with Crouzon Syndrome: Eight-Year Follow-up, Genetic Considerations, and Operative Management

“…Given the differences in the shape of the forehead between the two girls, these implants had to be significantly different to achieve similar postoperative results. Implant projection was based on the normal distance between brow and anterior corneal distance as demonstrated by Pai et al 16 Both patients underwent the operation during the same week to facilitate family needs and postoperative recovery (►Figs. 2 and 3).…”