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The Effect of Fronto-Orbital Advancement on Strabismus in Children With Unicoronal Synostosis

Lee, Shu Jin MRCS, MD*; Dondey, Joanne FRACS; Greensmith, Andrew MBChB, FRACS*; Holmes, Anthony D. FRACS*; Meara, John G. MD, MBA, FRACS

doi: 10.1097/SAP.0b013e31815a355c
Head and Neck Surgery

Unicoronal synostosis is frequently associated with strabismus. While the literature reports on the underlying bony dysmorphology and associated extraocular muscle dysfunction, the effect of the bony changes of fronto-orbital advancement has unpredictable effects on the strabismus associated with unicoronal synostosis. Previous authors have reported both resolution and new onset of strabismus following fronto-orbital advancement. The purpose of this study is to document the incidence of strabismus in patients with unicoronal synostosis and to assess the effect of fronto-orbital advancement on strabismus. A retrospective review of 20 patients with unicoronal synostosis was performed. The results demonstrated that 90% of our patients were noted to have strabismus preoperatively and this persisted postoperatively. Despite fronto-orbital advancement, strabismus persisted postoperatively. Seven (36.8%) required extraocular muscle surgery. In this series of patients with unicoronal synostosis there was a higher incidence of strabismus than previously reported elsewhere. Correction of the recessed frontal bone with bilateral fronto-orbital advancement does not fully address the orbital bony dysmorphology or correct the extraocular muscle dysfunction associated with unicoronal synostosis.

From the *Department of Plastic and Maxillofacial Surgery, and †Department of Ophthalmology, Royal Children's Hospital, Melbourne, Australia; and ‡Department of Plastic Surgery, Children's Hospital Boston, Boston, MA.

Received June 11, 2007 and accepted for publication, after revision, September 4, 2007.

Reprints: John G. Meara, MD, DMD, MBA, Plastic Surgeon-in-Chief, Children's Hospital Boston, Boston, MA 02115. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.