Lif H, Nysjö J, Geoffroy M, Paternoster G, Taverne M, Khonsari R, Nowinski D
Department of Surgical Sciences, Plastic surgery, Uppsala University, Uppsala, Sweden.
Department of Information Technology, Visual information and interaction, Uppsala University, Uppsala, Sweden.
J Plast Reconstr Aesthet Surg. 2024 Dec;99:76-84. doi: 10.1016/j.bjps.2024.09.044. Epub 2024 Sep 18.
Preoperative severity of unicoronal synostosis varies greatly and involves the frontal bone, skull base and orbits. Degree of deformity affects long-term morphological and functional outcomes after surgery. The aim of this study was to describe the morphological heterogenicity and investigate its relation to patient-specific factors.
In this retrospective cohort study, non-syndromic unicoronal synostosis patients treated between 2006 and 2022 at Necker Hospital, France or Uppsala University Hospital, Sweden, were included and matched to controls. Severity of skull base, orbital and posterior skull asymmetry, degree of anterior plagiocephaly and Harlequin deformity, lateralisation, head circumference, age, timing of metopic fusion and fusion of peri-pterionic sutures were investigated.
Ninety-five patients and ninety-three controls were included. Skull base asymmetry was linearly related to orbital asymmetry (p < 0.001), correlated with earlier CT scans (p = 0.004) and anterior (p < 0.001) and posterior (p = 0.03) plagiocephaly. Posterior plagiocephaly was more common in patients (31%) compared with controls (5%) (p < 0.001). A patent metopic suture above nine months of age was associated with severe Harlequin deformity (p = 0.04) and a lower head circumference when fused (p = 0.03). Fronto-sphenoidal suture fusion was associated with later CT scans (p < 0.001) and less skull base asymmetry (p = 0.002). Spheno-parietal fusion was correlated with decreased skull base asymmetry (p = 0.03). Right lateralisation was more common in females.
Heterogenicity of unicoronal synostosis seems to be predominantly explained by variability in skull base morphology. Peri-pterionic fusions might limit deformity.
单冠状缝早闭的术前严重程度差异很大，涉及额骨、颅底和眼眶。畸形程度会影响手术后的长期形态和功能结果。本研究的目的是描述形态学异质性，并研究其与患者特定因素的关系。
在这项回顾性队列研究中，纳入了2006年至2022年期间在法国内克尔医院或瑞典乌普萨拉大学医院接受治疗的非综合征性单冠状缝早闭患者，并与对照组进行匹配。研究了颅底、眼眶和后颅骨不对称的严重程度、前斜头畸形和丑角畸形的程度、侧化、头围、年龄、额缝融合时间和翼点周围缝线融合情况。
纳入了95例患者和93例对照。颅底不对称与眼眶不对称呈线性相关（p < 0.001），与早期CT扫描（p = 0.004）以及前（p < 0.001）后（p = 0.03）斜头畸形相关。与对照组（5%）相比，患者中后斜头畸形更为常见（31%）（p < 0.001）。9个月龄以上额缝未闭与严重丑角畸形（p = 0.04）以及融合时头围较小（p = 0.03）相关。额蝶缝融合与较晚的CT扫描（p < 0.001）和较轻的颅底不对称（p = 0.002）相关。蝶顶缝融合与颅底不对称减轻相关（p = 0.03）。右侧化在女性中更为常见。
单冠状缝早闭的异质性似乎主要由颅底形态的变异性所解释。翼点周围融合可能会限制畸形。
