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Anthropometric Study of Synostotic Frontal Plagiocephaly: Before and after Fronto-Orbital Advancement with Correction of Nasal Angulation

Meara, John G. M.D., D.M.D.; Burvin, Ram M.D.; Bartlett, Richard A. M.D.; Mulliken, John B. M.D.

Plastic and Reconstructive Surgery: September 1st, 2003 - Volume 112 - Issue 3 - p 731-738
doi: 10.1097/01.PRS.0000069707.18185.23

Surgical correction of synostotic frontal plagiocephaly (unilateral coronal synostosis) focuses on the asymmetry of the forehead and orbits. However, there is controversy regarding whether nasal angulation should be addressed during primary fronto-orbital advancement in infancy. This prospective study was undertaken to answer that question. Preoperative and postoperative anthropometric measurements were obtained for 19 infants with nonsyndromic synostotic frontal plagiocephaly. The measurements included nasal angulation, nasion-to-endocanthion distance, nasion-to-exocanthion distance, and exocanthion-to-tragion distance. All patients underwent bilateral parallelogrammatic fronto-orbital correction. Closing wedge nasal ostectomy was performed for group I (n = 14) and was not performed for group II (n = 5). The average age at the time of follow-up assessments was 3 years 8 months (range, 1 to 14 years) in group I and 5 years 5 months (range, 2 to 15 years) in group II. A statistically significant change was observed for patients who underwent primary correction of nasal angulation; the change correlated with improved naso-orbital symmetry, as judged with nasion-to-endocanthion and nasion-to-exocanthion measurements (p < 0.01 and p < 0.05, respectively). Group I patients exhibited an average preoperative nasal angulation of 9.15 ± 0.8 degrees that decreased to 3.1 ± 0.6 degrees postoperatively (p < 0.01). Group II patients exhibited an average preoperative nasal angulation of 6.4 ± 0.7 degrees that was unchanged postoperatively at 7.2 ± 1 degrees. The improvement in nasal angulation in group I was particularly striking because the patients in group II exhibited, on average, a lesser degree of preoperative nasal deviation (p < 0.01). This prospective comparison of fronto-orbital correction of synostotic frontal plagiocephaly with and without nasal correction confirmed an earlier study and demonstrated that angulation of the nasal pyramid does not self-correct within 5 years after traditional bilateral fronto-orbital repair. Closing wedge nasal ostectomy results in improved nasal angulation and naso-orbital symmetry, without evidence of distortion or inhibition of nasal growth.

Boston, Mass.

From the Craniofacial Centre and Division of Plastic Surgery, Children’s Hospital, Harvard Medical School.

Received for publication January 4, 2002;

revised November 12, 2002.

John B. Mulliken, M.D.

Division of Plastic Surgery

Children’s Hospital

300 Longwood Avenue

Boston, Mass. 02115

©2003American Society of Plastic Surgeons