From the Division of Plastic Surgery, Department of Surgery, and the Department of Neurological Surgery, University of Washington; the Craniofacial Center, Seattle Children's Hospital; and the Division of Plastic Surgery, Department of Surgery, University of Colorado.
Plast Reconstr Surg. 2019 Jun;143(6):1703-1711. doi: 10.1097/PRS.0000000000005639.
The authors' purpose was to quantify the change in unicoronal synostosis symmetry between presentation (time 0), after fronto-orbital advancement (time 1), and 2 years later (time 2).
Bandeau/orbital symmetry ratios and skull base/midface twists were measured on computed tomographic scans of consecutive isolated unicoronal synostosis patients. Comparisons were made across three time points and against normal controls.
Forty-three unicoronal synostosis patients and 36 controls were included. The mean bandeau ratio (symmetry = 1) changed from 0.76 (time 0), to 1.13 (time 1), and then to 1.01 (time 2). The median bandeau ratio change from time 1 to time 2 was -9.1 percent and was impacted by the degree of time 1 asymmetry. The odds of a desired symmetric or overcorrected result (bandeau ratio > 1.0) at time 2 were increased in patients with less severe preoperative asymmetry (OR, 4.2; p = 0.04) and in those who obtained symmetry or overcorrection at surgery (OR, 4.9; p = 0.02). Craniofacial twist did not significantly change after surgery but decreased at time 2. Orbital height ratios were 1.08, 1.00, and then 1.02 at time 2, respectively. The orbital width ratio was not significantly impacted by surgery, remaining at 0.89 at time 2.
Overcorrection of the unicoronal synostosis bandeau resulted in these patients being five times more likely to have a desired result at time 2. Patients with a more severe brow presentation were four times more likely to be asymmetric at time 2. Orbital height was improved, but attention should be directed at addressing orbital width.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
作者的目的是量化单侧冠状缝早闭患者在术前（时间 0）、眶额前移术后（时间 1）和术后 2 年（时间 2）的单侧性对称性变化。
在连续的单侧冠状缝早闭患者的计算机断层扫描图像上测量头带/眶对称性比和颅底/中面部扭转。在三个时间点进行比较，并与正常对照组进行比较。
共纳入 43 例单侧冠状缝早闭患者和 36 例对照组。头带比（对称性=1）从时间 0 的 0.76 变为时间 1 的 1.13，然后变为时间 2 的 1.01。从时间 1 到时间 2 的中位数头带比变化为-9.1%，且受术前不对称程度的影响。在术前不对称程度较轻的患者（比值比，4.2；p=0.04）和手术中获得对称或过矫正结果的患者（比值比，4.9；p=0.02）中，时间 2 获得期望的对称或过矫正结果（头带比>1.0）的可能性增加。手术后颅面扭转无明显变化，但在时间 2 时下降。眶高比分别为时间 2 的 1.08、1.00 和 1.02。眶宽比受手术影响不明显，时间 2 时仍为 0.89。
单侧冠状缝早闭患者的头带过度矫正使其在时间 2 时更有可能获得期望的结果。术前眉弓表现较严重的患者在时间 2 时更有可能不对称。眶高得到改善，但应注意解决眶宽问题。
临床问题/证据水平：风险，III。
