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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
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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: john.meara@childrens.harvard.edu.

© 2008 Lippincott Williams & Wilkins, Inc.