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Analysis of the Long-Term Outcomes of Nonsyndromic Bicoronal Synostosis

Bastidas, Nicholas M.D.; Mackay, Duncan D. J. B.A.; Taylor, Jesse A. M.D.; Bartlett, Scott P. M.D.

Plastic and Reconstructive Surgery: October 2012 - Volume 130 - Issue 4 - p 877–883
doi: 10.1097/PRS.0b013e318262f2fd
Pediatric/Craniofacial: Original Articles

Background: Isolated nonsyndromic bicoronal synostosis is a relatively rare entity that produces a characteristic turribrachycephalic skull shape. The purpose of this study was to evaluate the long-term outcomes of the isolated nonsyndromic bicoronal synostosis patients treated at the authors’ institution.

Methods: A retrospective chart review of all patients who underwent cranial vault remodeling for nonsyndromic bicoronal synostosis was performed at the Children’s Hospital of Philadelphia from 1991 to 2011. Fifteen patients were identified for this study, and information regarding their demographic, perioperative, and postoperative details was analyzed.

Results: Four boys and 11 girls were identified for inclusion in this study. The average age at the time of the initial surgery was 9.5 months, with an average follow-up of 13.4 years. There were no reported complications. Six patients with at least a 10-year follow-up (six of 10 patients) underwent revision for contour improvement in the forehead and temporal regions, and two patients required a repeated fronto-orbital advancement. Four patients underwent subsequent strabismus surgery. No patients were documented to have midface hypoplasia requiring orthognathic surgery. One patient with an associated diagnosis of autism was noted to have significant developmental delay.

Conclusions: Isolated nonsyndromic bicoronal synostosis confers a high rate of revisions for contour deformities but is associated with a low risk of complications. Overall, nonsyndromic patients require less secondary fronto-orbital advancement when compared with syndromic patients. In contrast to the syndromic population, there were no instances of midface hypoplasia necessitating surgery. There did not appear to be significant correlation between bicoronal synostosis and developmental abnormalities or delays.

Philadelphia, Pa.

From the Children’s Hospital of Philadelphia.

Received for publication March 28, 2012; accepted April 17, 2012.

Presented at the 58th Annual Meeting of the Robert H. Ivy Society, in Philadelphia, Pennsylvania, March 9 through 10, 2012.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Scott P. Bartlett, M.D., Children’s Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, Pa. 19102,

©2012American Society of Plastic Surgeons