Marchac D, Renier D, Arnaud E
Center for Craniofacial Anomalies, Hôpital Necker Enfants Malades, Paris, France.
Plast Reconstr Surg. 1995 Apr;95(5):802-11.
Consequences of early frontocranial remodeling are controversial. It has been said that secondary operations are more difficult and that the frontal sinus does not develop well, with an adverse effect on forehead aesthetics. Some illustrative cases are presented, among 820 operated craniosynostoses, to demonstrate that (1) an early, well-performed frontal advancement and/or remodeling is followed by satisfactory reossification and permits easy secondary surgery, (2) frontal sinus development, which is always impaired in anterior craniosynostosis, is only moderately diminished by early supraorbital bar remodeling (when the frontal bar is repositioned after remodeling, as with trigonocephaly, the frontal sinus develops in 83 percent of cases, whereas when the advancement is significant, as with brachycephaly, the development of the frontal sinus is observed in only 50 percent of the cases), and (3) forehead aesthetics are not linked closely to the development of the frontal sinus. After a significant advancement, even if the sinus does not develop, the frontal bar projection can remain satisfactory.
早期额颅重塑的后果存在争议。有人认为二次手术难度更大，额窦发育不良，对前额美观有不利影响。本文在820例接受手术治疗的颅缝早闭病例中列举了一些典型案例，以证明：（1）早期进行的、操作得当的额部前移和/或重塑术后会有令人满意的再骨化，且二次手术容易进行；（2）前颅缝早闭时额窦发育总是受损，但早期眶上缘重塑对其发育的影响较小（在三角头畸形中，重塑后重新定位额骨条时，83%的病例额窦会发育；而在短头畸形中，前移幅度较大时，只有50%的病例观察到额窦发育）；（3）前额美观与额窦发育并无紧密联系。大幅前移后，即使窦未发育，额骨条的突出度仍可令人满意。
