Melbourne, Victoria, Australia From the Departments of Plastic and Maxillofacial Surgery and Neurosurgery, Royal Children's Hospital Melbourne; and the Department of Paediatrics, University of Melbourne.
Plast Reconstr Surg. 2014 Nov;134(5):787e-795e. doi: 10.1097/PRS.0000000000000588.
The authors compared cranial growth across three patterns of fronto-orbital remodeling for metopic synostosis.
The authors reviewed all patients who underwent fronto-orbital remodeling for isolated metopic synostosis between 2006 and 2009. Inclusion criteria consisted of patients with preoperative, short-term postoperative (4 to 12 months), and long-term postoperative (>36 months) three-dimensional photographs. Patients were categorized by fronto-orbital remodeling pattern: group 1, retrocoronal; group 2, partial coronal; and group 3, precoronal. Head circumference, minimum frontal breadth (ft-ft), and maximum cranial length were measured by three-dimensional photographs, converted to standard Z scores, and compared.
Thirty-one patients met inclusion criteria (group 1, n=12; group 2, n=10; and group 3, n=9). Group 1 presented with the greatest phenotypic severity. From preoperative to short-term postoperative assessment, head circumference Z scores rose for group 1 but dropped for groups 2 and 3, and the three groups demonstrated equivalent increases in minimum frontal breadth Z scores. From short-term to long-term postoperatively, the three groups demonstrated similar stability in head circumference Z scores but decreased minimum frontal breadth Z scores. From preoperatively to long-term postoperatively, head circumference Z scores rose for group 1 but fell for groups 2 and 3 (change in Z score, 0.5, -0.5, and -0.7, respectively; p=0.06) and the three groups demonstrated equivalent drops in minimum frontal breadth Z scores. Across preoperative to short-term postoperative and preoperative to long-term postoperative assessment, group 1 displayed the least drop in maximum cranial length Z scores.
Retrocoronal patterns of fronto-orbital remodeling provide long-term gains in head circumference percentile and the least growth impairment in cranial length. Irrespective of osteotomy design, expansion in frontal breadth relapses significantly over time.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
作者比较了三种额眶重塑模式下的颅面生长情况，以评估矢状缝早闭的治疗效果。
作者回顾了 2006 年至 2009 年间所有接受单纯性矢状缝早闭额眶重塑的患者。纳入标准包括术前、短期术后（4 至 12 个月）和长期术后（>36 个月）的三维照片。根据额眶重塑模式将患者分为三组：第 1 组为冠状后组，第 2 组为部分冠状组，第 3 组为冠状前组。通过三维照片测量头围、最小额宽（ft-ft）和最大颅长，转换为标准 Z 评分并进行比较。
31 例患者符合纳入标准（第 1 组 12 例，第 2 组 10 例，第 3 组 9 例）。第 1 组的表型严重程度最高。从术前到短期术后评估，第 1 组的头围 Z 评分升高，第 2 组和第 3 组的头围 Z 评分降低，三组最小额宽 Z 评分均有同等程度的增加。从短期到长期术后，三组的头围 Z 评分均保持稳定，但最小额宽 Z 评分降低。从术前到长期术后，第 1 组的头围 Z 评分升高，第 2 组和第 3 组的头围 Z 评分降低（Z 评分变化分别为 0.5、-0.5 和-0.7，p=0.06），三组最小额宽 Z 评分均有同等程度的降低。从术前到短期术后和术前到长期术后评估，第 1 组最大颅长 Z 评分下降幅度最小。
冠状后额眶重塑模式可长期增加头围百分位数，对颅长生长的影响最小。无论截骨设计如何，额宽扩张都会随着时间的推移显著复发。
临床问题/证据水平：治疗性，III 级。
