Deraje Vybhav, Jirapinyo Chutima, Taranath Ajay, Anderson Peter J, Moore Mark H
Australian Craniofacial Unit.
Department of Medical Imaging, Women's and Children's Hospital, Adelaide, Australia.
J Craniofac Surg. 2020 May/Jun;31(3):707-710. doi: 10.1097/SCS.0000000000006232.
The impact of fronto-orbital advancement (FOA) on frontal sinus development and function is anecdotally variable. The aim of this study was to assess the impact of FOA on development of frontal sinuses, and additionally to identify the complications that might arise out of such procedures. This was a retrospective case-control study. Non-syndromic and syndromic craniosynostosis patients (n = 58) who underwent FOA at an early age and also had a skull radiograph or CT scan after the age of 12 were selected. Age matched trauma patients with CT scans done beyond 12 years of age were used as controls. Age at first FOA surgery, total number of procedures and age at imaging was noted. Presence or absence of frontal sinuses was assessed using imaging studies initially. Patients with a formed frontal sinus and a CT scan were further chosen for volumetric studies. Complications related to frontal sinus and secondary surgeries were recorded. One of 27 non-syndromic patients had absent frontal sinuses. Seven of 31 syndromic patients had absent sinuses. Among 20 controls, only 1 patient did not develop frontal sinuses. The mean age at first FOA was 11.81 months and 18.25 months for non-syndromic and syndromic groups, respectively. The average number of procedures before 12 years of age was 1.25 and 1.51 for non-syndromic and syndromic patients, respectively. The mean age at imaging was 17.74, 20.96, and 20.25 years for non-syndromic, syndromic and control groups, respectively. The mean frontal sinus volumes were 13050.36, 15039.02, and 8459.48 mm for non-syndromic, syndromic and control groups, respectively. In conclusion, FOA does not seem to have an impact on rate of pneumatization in the background of similar rates in the non-syndromic and control groups. The low pneumatization rate in syndromic group might be a virtue of the disease itself. There were significant frontal sinus complications that occurred after fronto orbital advancement and this should be borne in mind during the surgical consenting process.
额眶前移术（FOA）对额窦发育和功能的影响，据传闻存在差异。本研究的目的是评估FOA对额窦发育的影响，并另外确定此类手术可能出现的并发症。这是一项回顾性病例对照研究。选取了在幼年时接受FOA且在12岁后进行过颅骨X光片或CT扫描的非综合征性和综合征性颅缝早闭患者（n = 58）。将12岁以后进行过CT扫描的年龄匹配的创伤患者作为对照。记录首次FOA手术时的年龄、手术总次数以及成像时的年龄。最初使用影像学研究评估额窦的有无。进一步选取有已形成额窦且进行过CT扫描的患者进行容积研究。记录与额窦及二次手术相关的并发症。27例非综合征性患者中有1例无额窦。31例综合征性患者中有7例无额窦。在20例对照中，只有1例未发育额窦。非综合征性组和综合征性组首次FOA的平均年龄分别为11.81个月和18.25个月。非综合征性和综合征性患者在12岁前的平均手术次数分别为1.25次和1.51次。非综合征性组、综合征性组和对照组成像时的平均年龄分别为17.74岁、20.96岁和20.25岁。非综合征性组、综合征性组和对照组的平均额窦容积分别为13050.36立方毫米、15039.02立方毫米和8459.48立方毫米。总之，在非综合征性组和对照组发生率相似的情况下，FOA似乎对气化率没有影响。综合征性组的低气化率可能是疾病本身所致。额眶前移术后出现了显著的额窦并发症，在手术知情同意过程中应牢记这一点。
