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Long-Term Results following Fronto-Orbital Reconstruction in Nonsyndromic Unicoronal Synostosis

Selber, Jesse Creed M.D., M.P.H.; Brooks, Christopher M.D.; Kurichi, Jibby E. M.P.H.; Temmen, Traci M.D.; Sonnad, Seema S. Ph.D.; Whitaker, Linton A. M.D.

Plastic and Reconstructive Surgery: May 2008 - Volume 121 - Issue 5 - p 251e-260e
doi: 10.1097/PRS.0b013e31816a9f88
PEDIATRIC/CRANIOFACIAL: ORIGINAL ARTICLES
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Background: Fronto-orbital reconstruction is the standard of care for repair of unilateral coronal synostosis. This study examined the relationship between age at initial surgery and need for secondary surgery, to determine the optimal age for reconstruction.

Methods: The series comprised 81 patients with unicoronal synostosis who underwent reconstruction over a 30-year period by a single surgeon. Measured outcomes included reoperation rate, relapse/defect rate, relapse interval, and problem rate.

Results: Average age at surgery was 11.3 months (range, 1.5 to 71 months). The problem rate was 27.2 percent. Mean follow-up was 69 months (range, 6 to 234 months). The postoperative defect rate was 73 percent. Sixteen patients (20 percent) underwent reoperation to correct secondary deformities. Whitaker category I or II results were achieved in 90.1 percent. Problem rates for patients aged 0 to 6 months, 6 to 12 months, and older than 12 months were 13.3, 28, and 35, respectively. Secondary surgery was performed in 40 percent of patients whose first surgery was at 0 to 6 months, 7 percent aged 6 to 12 months, and 30.4 percent older than 12 months. After surgery, 87 percent of patients aged 0 to 6 months, 95 percent aged 6 to 12 months, and 87 percent older than 12 months had Whitaker category I or II results.

Conclusions: Fronto-orbital advancement at younger than 6 months had the highest incidence of readvancement. Patients treated at 6 to 12 months had the least need for any secondary surgery; however, patients older than 12 months had the lowest incidence of readvancement. These results indicate that fronto-orbital advancement should be delayed until at least age 6 months to avoid relapse.

Philadelphia, Pa.; and Hollywood and Tampa, Fla.

From the Division of Plastic Surgery and Department of Surgery, Hospital of the University of Pennsylvania, and the Children’s Hospital of Philadelphia; private practice; and the Department of Surgery, University of South Florida.

Received for publication October 10, 2006; accepted May 1, 2007.

Presented at the 11th Biennial International Conference of the International Society of Craniofacial Surgery, in Queensland, Australia, September 11 through 14, 2005; and at Plastic Surgery 2005: Annual Meeting of the American Society of Plastic Surgeons, in Chicago, Illinois, September 24 through 28, 2005.

Disclosure:There are no commercial associations that pose or create a conflict of interest with information presented in this article.

Linton A. Whitaker, Division of Plastic Surgery, 10 Penn Tower, 3400 Spruce Street, Philadelphia, Pa. 19104,

©2008American Society of Plastic Surgeons