Taylor Jesse A, Paliga J Thomas, Wes Ari M, Tahiri Youssef, Goldstein Jesse A, Whitaker Linton A, Bartlett Scott P
Philadelphia, Pa. From the Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, and The Children's Hospital of Philadelphia.
Plast Reconstr Surg. 2015 Jan;135(1):220-231. doi: 10.1097/PRS.0000000000000829.
This study reports long-term aesthetic outcomes with fronto-orbital advancement and cranial vault remodeling in treating unicoronal synostosis over a 35-year period.
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.
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].
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.
本研究报告了35年间采用额眶前移术和颅穹窿重塑术治疗单侧冠状缝早闭的长期美学效果。
对1977年至2012年孤立性单侧冠状缝早闭患者进行回顾性研究。对人口统计学、术前表型和长期美学效果数据进行分析，分类数据采用卡方检验和Fisher精确检验，连续数据采用Wilcoxon秩和检验和Kruskal-Wallis秩检验。
共治疗238例患者；207例符合纳入标准。无一例因颅内压问题接受二次干预。在确定性干预时，有96例（55%）惠特克I级患者，11例（6%）II级，62例（35%）III级，6例（3%）IV级。鼻根偏斜和枕部隆突各自使惠特克III/IV级风险增加[比值比（OR），4.4（1.4至13.9），p = 0.011；OR，2.6（1.0至6.8），p = 0.049]。与接受严格单侧手术的患者相比，接受双侧颅穹窿重塑联合延长单侧头带的患者在最近一次随访时惠特克III/IV级的可能性较小[OR，0.2（0.1至0.7），p = 0.011]。过度矫正导致颞部凹陷风险降低[OR，0.3（0.1至1.0），p = 0.05]。随访5年或更长时间的患者更有可能出现眶上退缩[OR，7.2（2.2至23.4），p = 0.001]和颞部凹陷[OR，3.7（1.5至9.6），p = 0.006]，且惠特克III/IV级结局的可能性更大[OR，4.9（1.8至12.8），p = 0.001]。
传统的额眶前移术和颅穹窿重塑术似乎可降低颅内压风险，但随着患者成熟可能导致美学缺陷，即额眶退缩和颞部凹陷。
临床问题/证据级别：治疗性，IV级。
