Meara John G, Burvin Ram, Bartlett Richard A, Mulliken John B
Craniofacial Centre and Division of Plastic Surgery, Children's Hospital, Harvard Medical School, Boston, Mass. 02115, USA.
Plast Reconstr Surg. 2003 Sep;112(3):731-8. doi: 10.1097/01.PRS.0000069707.18185.23.
Surgical correction of synostotic frontal plagiocephaly (unilateral coronal synostosis) focuses on the asymmetry of the forehead and orbits. However, there is controversy regarding whether nasal angulation should be addressed during primary fronto-orbital advancement in infancy. This prospective study was undertaken to answer that question. Preoperative and postoperative anthropometric measurements were obtained for 19 infants with nonsyndromic synostotic frontal plagiocephaly. The measurements included nasal angulation, nasion-to-endocanthion distance, nasion-to-exocanthion distance, and exocanthion-to-tragion distance. All patients underwent bilateral parallelogrammatic fronto-orbital correction. Closing wedge nasal ostectomy was performed for group I (n = 14) and was not performed for group II (n = 5). The average age at the time of follow-up assessments was 3 years 8 months (range, 1 to 14 years) in group I and 5 years 5 months (range, 2 to 15 years) in group II. A statistically significant change was observed for patients who underwent primary correction of nasal angulation; the change correlated with improved naso-orbital symmetry, as judged with nasion-to-endocanthion and nasion-to-exocanthion measurements (p < 0.01 and p < 0.05, respectively). Group I patients exhibited an average preoperative nasal angulation of 9.15 +/- 0.8 degrees that decreased to 3.1 +/- 0.6 degrees postoperatively (p < 0.01). Group II patients exhibited an average preoperative nasal angulation of 6.4 +/- 0.7 degrees that was unchanged postoperatively at 7.2 +/- 1 degrees. The improvement in nasal angulation in group I was particularly striking because the patients in group II exhibited, on average, a lesser degree of preoperative nasal deviation (p < 0.01). This prospective comparison of fronto-orbital correction of synostotic frontal plagiocephaly with and without nasal correction confirmed an earlier study and demonstrated that angulation of the nasal pyramid does not self-correct within 5 years after traditional bilateral fronto-orbital repair. Closing wedge nasal ostectomy results in improved nasal angulation and naso-orbital symmetry, without evidence of distortion or inhibition of nasal growth.
骨性融合性额部斜头畸形（单侧冠状缝早闭）的手术矫正主要针对前额和眼眶的不对称。然而，对于婴儿期初次额眶前移手术时是否应处理鼻角存在争议。本前瞻性研究旨在回答这一问题。对19例非综合征性骨性融合性额部斜头畸形婴儿进行了术前和术后人体测量。测量指标包括鼻角、鼻根至内眦距离、鼻根至外眦距离以及外眦至耳屏距离。所有患者均接受了双侧平行四边形额眶矫正术。I组（n = 14）进行了闭合楔形鼻骨切除术，II组（n = 5）未进行。I组随访评估时的平均年龄为3岁8个月（范围1至14岁），II组为5岁5个月（范围2至15岁）。接受鼻角初次矫正的患者出现了具有统计学意义的变化；该变化与鼻眶对称性改善相关，通过鼻根至内眦和鼻根至外眦测量判断（分别为p < 0.01和p < 0.05）。I组患者术前平均鼻角为9.15±0.8度，术后降至3.1±0.6度（p < 0.01）。II组患者术前平均鼻角为6.4±0.7度，术后无变化，为7.2±1度。I组鼻角的改善尤为显著，因为II组患者术前平均鼻偏程度较小（p < 0.01）。这项对有或无鼻矫正的骨性融合性额部斜头畸形额眶矫正的前瞻性比较证实了一项早期研究，并表明在传统双侧额眶修复术后5年内，鼻锥体角度不会自行矫正。闭合楔形鼻骨切除术可改善鼻角和鼻眶对称性，且无鼻生长变形或抑制的证据。
