1Division of Plastic and Reconstructive Surgery, Washington University in St. Louis.
2Division of Pediatric Neurosurgery, Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.
J Neurosurg Pediatr. 2022 Feb 25;29(5):560-567. doi: 10.3171/2022.1.PEDS21401. Print 2022 May 1.
Outcomes research on unilateral coronal synostosis is mostly limited to the early postoperative period. This study examines facial asymmetry, desire for revision, and patient-reported outcomes at school age in children who received either endoscopic strip craniectomy with helmet therapy or fronto-orbital advancement (open repair).
Patients with repaired unilateral coronal synostosis born between 2000 and 2017, with 3D photographs taken when they were between 3.5 and 8 years of age, were eligible for study inclusion. Three pairs of bilateral linear measurements and two angular measurements were taken. Parent- and physician-reported desire for revision and patient-reported outcomes (Patient-Reported Outcomes Measurement Information System cognitive function and Quality of Life in Neurological Disorders stigma scores) were collected from patient charts.
Thirty-five patients qualified, including 25 with open repair and 10 with endoscopic repair. The median patient ages at repair were 3 months and 8 months in the endoscopic and open groups, respectively. The average ages at final 3D photography were 5.8 years and 5.5 years in the endoscopic and open groups, respectively. Digital anthropometry revealed no significant differences in measures of facial asymmetry between the repair groups (p ≥ 0.211). Midface depth (tragion to subnasale) was significantly less symmetric at school age than other linear measures (F(2,102) = 9.14, p < 0.001). Forehead asymmetry was significantly associated with parent- and physician-reported desire for revision (p ≤ 0.006). No significant associations were found between physical asymmetry and patient-reported stigma or cognitive function (p > 0.046, Holm-Bonferroni correction).
Children who underwent open or endoscopic repair for unilateral coronal synostosis have comparable facial symmetry at school age, but midface depth remains highly asymmetrical in both groups. Forehead asymmetry at school age correlates with parent- and physician-reported desire for revision.
单侧冠状缝早闭的术后结果研究大多仅限于术后早期。本研究检查了接受内镜颅骨切除术联合头盔治疗或额眶成形术（开放式修复）的儿童在学龄期的面部不对称、修复意愿和患者报告的结果。
研究纳入了 2000 年至 2017 年间接受修复单侧冠状缝早闭的患儿，他们在 3.5 至 8 岁时拍摄了 3D 照片。共测量了三组双侧线性指标和两组角度指标。从病历中收集了父母和医生报告的修复意愿和患者报告的结果（患者报告的结果测量信息系统认知功能和神经障碍患者生活质量污名评分）。
35 名患者符合条件，其中 25 名接受了开放式修复，10 名接受了内镜式修复。内镜组和开放组的平均修复年龄分别为 3 个月和 8 个月，最终 3D 摄影的平均年龄分别为 5.8 岁和 5.5 岁。数字人体测量学显示两组修复组的面部不对称测量值无显著差异（p≥0.211）。与其他线性指标相比，学龄期的中面部深度（泪点至鼻下点）明显不对称（F(2,102)=9.14，p<0.001）。额部不对称与父母和医生报告的修复意愿显著相关（p≤0.006）。未发现身体不对称与患者报告的污名或认知功能之间存在显著相关性（p>0.046， Holm-Bonferroni 校正）。
接受单侧冠状缝早闭开放或内镜修复的儿童在学龄期面部对称性相当，但两组的中面部深度仍高度不对称。学龄期的额部不对称与父母和医生报告的修复意愿相关。
