Division of Plastic Surgery, University of Florida, Gainesville, FL, USA.
Harvard T. H. Chan School of Public Health, Boston, MA, USA.
J Plast Reconstr Aesthet Surg. 2024 Mar;90:122-129. doi: 10.1016/j.bjps.2024.01.018. Epub 2024 Feb 1.
Craniofacial asymmetry associated with unicoronal synostosis (UCS) may persist into the teenage years despite surgery in infancy. This study evaluated outcomes following a nasal monobloc procedure by mobilizing a united nasomaxillary and bilateral medial orbital segment of bone (nasal monobloc) to perform corrective translational and rotational movement for secondary correction of residual nasal-orbital asymmetry associated with UCS.
A retrospective review of all UCS patients treated with nasal monobloc at our institution was performed. Demographic information was recorded, and pre- and postoperative 2D imaging was used for morphometric outcome analysis. Outcomes and complications were tabulated.
The study included 14 patients (5 males, 9 females; mean age 14.6 years; range 9.6 to 22.5 years; mean follow-up 70.6 months range 12 to 132 months). Ancillary procedures (scar revision, forehead/orbital contouring, MEDPOR® augmentation) were performed in all patients at the time of the nasal monobloc. One patient underwent a repeat procedure 6 years later following technique modification. Additionally, another patient experienced late overgrowth of the frontal sinus with forehead asymmetry. The morphometric analysis demonstrated significant (p < 0.05) pre-op to post-op improvements in naso-orbital asymmetry, as demonstrated by horizontal orbital aperture ratio (0.88 vs 0.99), midline to exocanthion ratio (0.91 vs 0.98), orbital index ratio (1.15 vs 1.01), and midline discrepancy (7.1 degrees vs 2.7 degrees).
Nasal monobloc osteotomy provides a reasonable surgical treatment to improve both the nasal and orbital asymmetries associated with unicoronal synostosis, including frontal nasal deviation, basal nasal deviation, and orbital aperture asymmetry. It is important to note that confounding anatomic variables such as globe dystopia, strabismus, and scleral show may affect the perception of orbital symmetry.
尽管婴儿期进行了手术，与单侧冠状缝早闭（UCS）相关的颅面不对称仍可能持续到青少年时期。本研究通过移动联合的鼻上颌和双侧内侧眶段骨（鼻整块）来评估鼻整块手术的结果，以进行二次矫正 UCS 相关的残留鼻眶不对称的矫正性平移和旋转运动。
对我院接受鼻整块治疗的所有 UCS 患者进行回顾性分析。记录人口统计学信息，并使用术前和术后 2D 成像进行形态计量学结果分析。总结了结果和并发症。
该研究纳入了 14 名患者（5 名男性，9 名女性；平均年龄 14.6 岁；范围 9.6 至 22.5 岁；平均随访 70.6 个月，范围 12 至 132 个月）。所有患者在接受鼻整块手术时均进行了辅助手术（瘢痕修整、额眶轮廓整形、MEDPOR® 填充）。1 例患者在技术修改 6 年后再次接受手术。此外，另 1 例患者发生额窦晚期过度生长伴额部不对称。形态计量学分析显示，鼻眶不对称的术前至术后改善具有显著意义（p<0.05），表现为水平眶孔径比（0.88 比 0.99）、中线至外眼角比（0.91 比 0.98）、眶指数比（1.15 比 1.01）和中线差异（7.1 度比 2.7 度）。
鼻整块截骨术是一种合理的手术治疗方法，可改善与单侧冠状缝早闭相关的鼻和眶不对称，包括额鼻偏斜、基底鼻偏斜和眶孔径不对称。需要注意的是，眼球异位、斜视和巩膜显露等混杂的解剖学变量可能会影响对眶对称性的感知。
