Whitaker L A, Bartlett S P, Schut L, Bruce D
Plast Reconstr Surg. 1987 Aug;80(2):195-212.
Treatment options for the craniosynostoses vary from conservative observation until completion of growth to radical remodeling in infancy. To further define the timing and type of treatment necessary in these complex disorders, we have retrospectively analyzed all patients operated on for this deformity during the past 12 years. One-hundred and sixty-four patients with craniosynostosis were analyzed and subgrouped into asymmetrical (predominantly unilateral) and symmetrical (bilateral) deformities, in addition to segregation by age and type of procedure performed. This was done recognizing that no deformity, like no normal human face, is truly symmetrical. Results of treatment were categorized on the basis of the need for additional surgery and varied from no refinements necessary (category I) to major reduplication of the initial procedure (category IV). Analysis of the data led us to conclude that excellent results can be expected in the asymmetrical deformities group treated in infancy by a unilateral approach. Similarly, for the mild symmetrical deformities, treatment at this time by bilateral orbital advancement gives satisfactory results in the majority of patients. By contrast, the more severe symmetrical groups treated in childhood have a high incidence of requiring secondary major reconstructions, and consideration should be given to delaying craniofacial surgery until age 7 or older, although earlier cranial surgery may be advisable.
颅缝早闭的治疗方案多种多样，从保守观察直至生长完成，到婴儿期的根治性重塑。为了进一步明确这些复杂病症所需治疗的时机和类型，我们回顾性分析了过去12年中所有因这种畸形接受手术的患者。对164例颅缝早闭患者进行了分析，并根据年龄和所施行手术的类型进行分组，此外还分为不对称（主要为单侧）和对称（双侧）畸形。这样做是因为认识到没有一种畸形，就像没有一张真正对称的人脸一样，是完全对称的。治疗结果根据是否需要再次手术进行分类，从无需进一步矫正（I类）到最初手术的严重重复（IV类）不等。数据分析使我们得出结论，婴儿期采用单侧方法治疗的不对称畸形组有望取得优异的效果。同样，对于轻度对称畸形，此时采用双侧眼眶前移治疗，大多数患者可获得满意的结果。相比之下，儿童期治疗的较严重对称组需要二次大型重建的发生率较高，应考虑将颅面手术推迟至7岁或更大年龄，不过早期进行颅骨手术可能是可取的。
