Craniofacial Symmetry Progression Following Strip Craniectomy in Unilateral Coronal Synostosis.

Harrison, Lucas M; Hallac, Rami R; Sanati-Mehrizy, Paymon; Seaward, James R; Kane, Alex A · Plast Reconstr Surg · 2025

prospective_cohort · Level II

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Abstract

Strip craniectomy in unilateral coronal synostosis (UCS) is associated with shorter operations, fewer complications, reduced transfusions, fewer ophthalmic disorders, and improved craniofacial morphology. However, the tempo and extent of changes in craniofacial features post-operatively are less well understood. The purpose of this study is to evaluate the progression of craniofacial symmetry over time following strip craniectomy in UCS. Eighteen patients with UCS were evaluated pre-operatively and at 3 months, 6 months, 1 year, and 2 years following strip craniectomy with helmet. Three-dimensional images were utilized to assess craniofacial asymmetries. Craniofacial composites were created. Eighteen control patients were included for comparison. Pre-operatively, brow projection asymmetry (92.51±4.23%; p<0.001), orbital width (89.26±6.57%; p=0.003), and height (118.42±7.79%; p=0.043) asymmetry, and mid-face asymmetry (91.42±3.14%; p<0.001) were significantly different between sides. There was cranial asymmetry (91.97±4.36%), decreased height of the ipsilateral orbit (6.50±1.09), contralateral forehead bossing (10.51±1.64), and nasal and chin deviation to the contralateral side (7.90±2.30; 5.86±1.48). By 3 months post-operatively, all craniofacial measurements had significantly improved from their pre-operative values (p<0.050). Cranial asymmetry (98.73±2.02%), frontal bossing (1.28 ± 0.27), brow projection asymmetry (98.34±1.27%), orbital height 102.47±8.40%) and vertical (0.84±0.46) asymmetry, and nasal and chin deviation (1.60±0.89; 1.17±0.59) were not significantly different from control at 2 years. Orbital width and mid-face asymmetry remained significantly different from controls. UCS patients demonstrated significant asymmetry pre-operatively, which all significantly improved by 3 months post-operatively. Most craniofacial features normalized compared to controls by 2 years post-operatively, except for orbital width and mid-face asymmetry.