From the Department of Plastic and Reconstructive Surgery, Korea University, College of Medicine, Korea University Anam Hospital.
Departments of Plastic and Reconstructive Surgery.
Plast Reconstr Surg. 2023 Jun 1;151(6):1275-1284. doi: 10.1097/PRS.0000000000010164. Epub 2023 Jan 3.
The surgical correction of unilateral coronal synostosis (UCS) aims to achieve longstanding facial and cranial symmetry. The authors hypothesized that endocranial morphology correction achieved by one-piece fronto-orbital advancement with distraction osteogenesis (FODO) could alleviate facial asymmetry because endocranial morphology is thought to be its major determinant. This study aimed to quantitatively analyze the changes in supraorbital and midfacial symmetry after FODO.
The authors included 27 patients with UCS who underwent FODO between May of 2008 and November of 2019. The supraorbital, midfacial, and orbital symmetry ratios and the endocranial and midface angles were measured using computed tomography images.
The mean follow-up period was 3.7 ± 1.9 years. The supraorbital shape became symmetric after FODO; the supraorbital distance ratio changed from 0.88 ± 0.04 to 0.98 ± 0.03 ( P < 0.001). The endocranial angulation improved from 167.5 ± 5.0 degrees to 174.4 ± 3.4 degrees ( P < 0.001) and the midface angulation decreased from 6.6 ± 2.2 degrees to 2.6 ± 1.9 degrees ( P < 0.001). In the long-term follow-up analysis (5.9 years), the endocranial angle experienced a slight relapse (-1.4% ± 0.9%) and supraorbital symmetry experienced a -2.0% ± 3.9% relapse. The midface angle continued to improve over the follow-up periods, but it was not statistically significant ( P = 0.121).
The authors' observations indicate that FODO produced satisfactory outcomes in correcting supraorbital retrusion and midface asymmetry. In addition, FODO may allow anterior cranial base remodeling and help relieve midface and skull base angulation. Therefore, FODO can be a good therapeutic strategy for correcting supraorbital and facial asymmetry in patients with UCS.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
单侧冠状缝早闭（UCS）的手术矫正旨在实现长期的面部和颅面对称性。作者假设，通过整块额眶前移加骨牵引成骨术（FODO）实现的颅内形态矫正，可以缓解面部不对称，因为颅内形态被认为是其主要决定因素。本研究旨在定量分析 FODO 后眶上和中面部对称性的变化。
作者纳入了 2008 年 5 月至 2019 年 11 月期间接受 FODO 的 27 例 UCS 患者。使用 CT 图像测量眶上、中面部和眶部对称比以及颅腔和中面部角度。
平均随访时间为 3.7 ± 1.9 年。FODO 后眶上形态变得对称；眶上距离比从 0.88 ± 0.04 变为 0.98 ± 0.03（P < 0.001）。颅腔角度从 167.5 ± 5.0 度改善至 174.4 ± 3.4 度（P < 0.001），中面部角度从 6.6 ± 2.2 度减小至 2.6 ± 1.9 度（P < 0.001）。在长期随访分析（5.9 年）中，颅腔角度略有回退（-1.4% ± 0.9%），眶上对称性回退-2.0% ± 3.9%。中面部角度在随访期间持续改善，但无统计学意义（P = 0.121）。
作者的观察表明，FODO 在矫正眶上后缩和中面部不对称方面取得了满意的效果。此外，FODO 可能允许前颅底重塑，并有助于缓解中面部和颅底角度。因此，FODO 可以成为治疗 UCS 患者眶上和面部不对称的良好治疗策略。
临床问题/证据水平：治疗性，IV 级。
