Fronto-facial Symmetry in Unilateral Coronal Synostosis:
Fronto-orbital Advancement vs. Endoscopic Suturectomy/Helmet Therapy
Stephan P. Tan, D.D.S., Mark R. Proctor, M.D., John B. Mulliken, M.D., Gary F. Rogers, M.D., J.D., M.B.A., M.P.H..
Children's Hospital Boston / Harvard Medical School, Boston, MA, USA.
Unilateral coronal synostosis causes asymmetry of the forehead and face. Fronto-orbital advancement is considered to be the gold standard for treatment in infancy, but our studies have shown it does not improve the facial asymmetry. Endoscopic suturectomy and helmet therapy has recently been proposed as a treatment alternative; however, there is little objective data to support the effectiveness of this method. The aim of the study was to utilize 3D photogrammetry to compare fronto-facial symmetry following operative treatment of unilateral coronal synostosis using fronto-orbital advancement (FOA) vs. endoscopic suturectomy and helmet therapy (ENDO).
All patients with unilateral coronal synostosis were treated at our center between 2004-2008. The parents of infants younger than 4 months were given a choice between fronto-orbital advancement and endoscopic suturectomy and helmet therapy. Infants older than 4 months underwent fronto-orbital advancement. Syndromic patients were excluded.
Three-dimensional digital photographs were taken for all patients; the 3D images were analyzed for fronto-facial symmetry using 3D photogrammetric software. The following paired anthropometric distances were measured: medial canthus to facial midline distance (endocanthion to sellion); mid-facial depth (tragion to subnasale); and lower facial depth (tragion to gnathion). Nasal tip deviation, facial midline deviation and brow projection were also measured.
Of the 22 patients included in the study, 11 underwent endoscopic suturectomy / helmet therapy and 11 had a fronto-orbital advancement.
All patients exhibited rotation of the middle and lower face to the nonfused side. Patients treated with endoscopic suturectomy and helmet therapy had significantly less nasal tip deviation (p = 0.006) and less facial midline deviation (p = 0.018) than those treated with fronto-orbital advancement. Patients in the ENDO group had better symmetry between left and right mid-facial depth (p = 0.042). Brow symmetry was comparable between the two groups.
Endoscopic suturectomy and helmet therapy resulted in better facial symmetry. ENDO and FOA resulted in comparable brow symmetry.
This study showed that endoscopic suturectomy and helmet therapy is an effective treatment alternative for unilateral coronal synostosis.
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