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A Critical Evaluation of Long-Term Aesthetic Outcomes of Fronto-Orbital Advancement and Cranial Vault Remodeling in Nonsyndromic Unicoronal Craniosynostosis

Taylor, Jesse A. M.D.; Paliga, J. Thomas B.A.; Wes, Ari M. B.A.; Tahiri, Youssef M.D.; Goldstein, Jesse A. M.D.; Whitaker, Linton A. M.D.; Bartlett, Scott P. M.D.

Plastic and Reconstructive Surgery: January 2015 - Volume 135 - Issue 1 - p 220–231
doi: 10.1097/PRS.0000000000000829
Pediatric/Craniofacial: Original Articles
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Background: This study reports long-term aesthetic outcomes with fronto-orbital advancement and cranial vault remodeling in treating unicoronal synostosis over a 35-year period.

Methods: Retrospective review was performed on patients with isolated unicoronal synostosis from 1977 to 2012. Demographic, preoperative phenotypic, and long-term aesthetic outcomes data were analyzed with chi-squared and Fisher’s exact test for categorical data and Wilcoxon rank-sum and Kruskal-Wallis rank for continuous data.

Results: A total of 238 patients were treated; 207 met inclusion criteria. None underwent secondary intervention for intracranial pressure. At definitive intervention, there 96 (55 percent) Whitaker class I patients, 11 (6 percent) class II, 62 (35 percent) class III, and six (3 percent) class IV. Nasal root deviation and occipital bossing each conferred an increased risk of Whitaker class III/IV [OR, 4.4 (1.4 to 13.9), p = 0.011; OR, 2.6 (1.0 to 6.8), p = 0.049]. Patients who underwent bilateral cranial vault remodeling with extended unilateral bandeau were less likely Whitaker class III/IV at latest follow-up compared with those undergoing strictly unilateral procedures [OR, 0.2 (0.1 to 0.7), p = 0.011]. Overcorrection resulted in decreased risk of temporal hollowing [OR, 0.3 (0.1 to 1.0), p = 0.05]. Patients with 5 years or more of follow-up were more likely to develop supraorbital retrusion [OR, 7.2 (2.2 to 23.4), p = 0.001] and temporal hollowing [OR, 3.7 (1.5 to 9.6), p = 0.006] and have Whitaker class III/IV outcomes [OR, 4.9 (1.8 to 12.8), p = 0.001].

Conclusion: Traditional fronto-orbital advancement and cranial vault remodeling appears to mitigate risk of intracranial pressure but may lead to aesthetic shortcomings as patients mature, namely fronto-orbital retrusion and temporal hollowing.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Philadelphia, Pa.

From the Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, and The Children’s Hospital of Philadelphia.

Received for publication February 21, 2014; accepted May 8, 2014

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

Presented at the 82nd Annual Meeting of the American Society of Plastic Surgeons, in San Diego, California, October 11 through 15, 2013; and the International Society of Craniofacial Surgery 15th Annual Congress, in Jackson Hole, Wyoming, September 10 through 14, 2013.

Jesse A. Taylor, M.D., Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Colket Translational Research Building, 3501 Civic Center Boulevard, 9th Floor, Philadelphia, Pa. 19104, taylorj5@email.chop.edu

©2015American Society of Plastic Surgeons