Improved Facial and Skull-base Symmetry Following Osteotomy and Distraction of Unilateral Coronal Synostosis.

OBJECTIVES: Unilateral coronal synostosis (UCS) results in a surgically demanding deformation, as the deformity is asymmetric in the calvarium but also presents with facial scoliosis and orbital dystopia. Traditional cranioplasties correct the forehead but have little effect on the face and orbits. Here, we describe a consecutive series of patients operated for UCS with osteotomy of the fused suture combined with distraction osteogenesis (FOD).

METHODS: Fourteen patients [mean age: 8.0 months (range: 4.3-16.6 months)] were included in this study. We measured and compared the orbital dystopia angle (ODA), anterior cranial fossa deviation (ACFD), and anterior cranial fossa cant (ACFC) between results from preoperative computed tomography and those at distractor removal.

RESULTS: Blood loss was 6.1 mL/kg (range: 2.0-15.2 mL/kg), and length of stay was 4.4 days (range: 3.0-6.0 days). We observed significant improvements in the ODA from [median (95% confidence interval)] -9.8° (-12.6° to -7.0°) to -1.1° (-3.7° to -1.5°) (p<0.001), ACFD from 12.9° (9.2-16.6°) to 4.7° (1.5-7.9°) (p<0.001), and ACFC from 2.5° (1.5-3.5°) to 1.7° (0.0-3.4) (p=0.003).

CONCLUSIONS: The results showed that osteotomy combined with a distractor for UCS straightened the face and relieved orbital dystopia by affecting the nose angle relative to the orbits, correcting the deviation of the cranial base in the anterior fossa, and lowering the orbit on the affected side. Furthermore, this technique demonstrated a favorable morbidity profile with low perioperative bleeding and a short inpatient period, suggesting its potential to improve the surgical treatment of UCS.