Wu Meagan, Wagner Connor S, Villavisanis Dillan F, Ng Jinggang J, Massenburg Benjamin B, Romeo Dominic J, Heuer Gregory G, Bartlett Scott P, Swanson Jordan W, Taylor Jesse A
Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Childs Nerv Syst. 2024 Dec 18;41(1):59. doi: 10.1007/s00381-024-06662-8.
In an effort to maximize benefit and minimize morbidity when performing fronto-orbital distraction osteogenesis (FODO) for unilateral coronal synostosis (UCS), we have transitioned to an endoscopic-assisted approach ("endo-FODO"). This study compares photogrammetric outcomes of patients who underwent FODO via an endoscopic-assisted versus open approach.
We retrospectively reviewed patients treated for UCS from 2013 to 2023. Photogrammetric outcomes at one to three years postoperatively were compared between patients who underwent endo-FODO and age- and sex-matched controls who underwent open FODO. Differences between pre- and postoperative periorbital symmetry ratios, canthal tilt symmetry, and orbital dystopia angle (ODA) were calculated.
Twenty patients (ten per group) underwent surgery at a mean age of 6.1 ± 1.8 and 5.4 ± 1.1 months (p = 0.426) and were photographed at 1.6 ± 0.9 and 1.8 ± 0.9 years (p = 0.597) postoperatively in the endo-FODO and open FODO groups, respectively. Patients who underwent endo-FODO demonstrated significant improvements in margin-reflex distance 1 (MRD1) symmetry ratio (p = 0.004), palpebral height symmetry ratio (p = 0.004), canthal tilt symmetry (p = 0.020), and ODA (p = 0.009). Patients who underwent open FODO likewise demonstrated significant improvements in MRD1 symmetry ratio (p = 0.004), palpebral height symmetry ratio (p = 0.033), and ODA (p = 0.004). All postoperative measurements as well as degrees of improvement were similar between groups (p > 0.05).
Endo- and open FODO were associated with significant and comparable improvements in soft tissue periorbital symmetry and orbital dystopia at nearly two years postoperatively. While continued follow-up until cranial maturity is needed to assess the durability of aesthetic results, these data support a minimally invasive, endoscopic alternative to fronto-orbital distraction.
为了在对单侧冠状缝早闭（UCS）进行额眶牵张成骨术（FODO）时使益处最大化并将发病率降至最低，我们已转而采用内镜辅助方法（“内镜FODO”）。本研究比较了通过内镜辅助与开放手术方法进行FODO的患者的摄影测量结果。
我们回顾性分析了2013年至2023年期间接受UCS治疗的患者。比较了接受内镜FODO的患者与年龄和性别匹配的接受开放FODO的对照组在术后1至3年的摄影测量结果。计算术前和术后眶周对称率、眦倾斜对称性和眶异位角（ODA）之间的差异。
20例患者（每组10例）接受了手术，内镜FODO组和开放FODO组的平均年龄分别为6.1±1.8个月和5.4±1.1个月（p = 0.426），术后分别在1.6±0.9年和1.8±0.9年进行了拍照（p = 0.597）。接受内镜FODO的患者在缘反射距离1（MRD1）对称率（p = 0.004）、睑裂高度对称率（p = 0.004）、眦倾斜对称性（p = 0.020）和ODA（p = 0.009）方面有显著改善。接受开放FODO的患者在MRD1对称率（p = 0.004）、睑裂高度对称率（p = 0.033）和ODA（p = 0.004）方面同样有显著改善。两组之间所有术后测量结果以及改善程度相似（p>0.05）。
内镜FODO和开放FODO在术后近2年时均与眶周软组织对称性和眶异位的显著且相当的改善相关。虽然需要持续随访至颅骨成熟以评估美学效果的持久性，但这些数据支持额眶牵张术的微创内镜替代方法。
