School-age outcomes in patients with unilateral coronal synostosis: comparison of fronto-orbital advancement and endoscopic strip craniectomy

View More View Less
  • 1 Division of Plastic and Reconstructive Surgery, Washington University in St. Louis;
  • | 2 Division of Pediatric Neurosurgery, Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online Sign in

OBJECTIVE

Outcomes research on unilateral coronal synostosis is mostly limited to the early postoperative period. This study examines facial asymmetry, desire for revision, and patient-reported outcomes at school age in children who received either endoscopic strip craniectomy with helmet therapy or fronto-orbital advancement (open repair).

METHODS

Patients with repaired unilateral coronal synostosis born between 2000 and 2017, with 3D photographs taken when they were between 3.5 and 8 years of age, were eligible for study inclusion. Three pairs of bilateral linear measurements and two angular measurements were taken. Parent- and physician-reported desire for revision and patient-reported outcomes (Patient-Reported Outcomes Measurement Information System cognitive function and Quality of Life in Neurological Disorders stigma scores) were collected from patient charts.

RESULTS

Thirty-five patients qualified, including 25 with open repair and 10 with endoscopic repair. The median patient ages at repair were 3 months and 8 months in the endoscopic and open groups, respectively. The average ages at final 3D photography were 5.8 years and 5.5 years in the endoscopic and open groups, respectively. Digital anthropometry revealed no significant differences in measures of facial asymmetry between the repair groups (p ≥ 0.211). Midface depth (tragion to subnasale) was significantly less symmetric at school age than other linear measures (F(2,102) = 9.14, p < 0.001). Forehead asymmetry was significantly associated with parent- and physician-reported desire for revision (p ≤ 0.006). No significant associations were found between physical asymmetry and patient-reported stigma or cognitive function (p > 0.046, Holm-Bonferroni correction).

CONCLUSIONS

Children who underwent open or endoscopic repair for unilateral coronal synostosis have comparable facial symmetry at school age, but midface depth remains highly asymmetrical in both groups. Forehead asymmetry at school age correlates with parent- and physician-reported desire for revision.

ABBREVIATIONS

CI = confidence interval; IQR = interquartile range; Neuro-QoL = Quality of Life in Neurological Disorders; PROMIS = Patient-Reported Outcomes Measurement Information System; RMS = root mean square.

Diagram from Behbahani et al. (pp 488–496).

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Masserano B, Woo AS, Skolnick GB, et al. The temporal region in unilateral coronal craniosynostosis: fronto-orbital advancement versus endoscopy-assisted strip craniectomy. Cleft Palate Craniofac J. 2018;55(3):423429.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Pfaff MJ, Wong K, Persing JA, Steinbacher DM. Zygomatic dysmorphology in unicoronal synostosis. J Plast Reconstr Aesthet Surg. 2013;66(8):10961102.

  • 3

    Derderian CAMD, Wink JDBA, Cucchiara A, Taylor JAMD, Bartlett SPMD. The temporal region in unilateral coronal craniosynostosis: a volumetric study of short- and long-term changes after fronto-orbital advancement. Plast Reconstr Surg. 2014;134(1):8391.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Meara JG, Burvin R, Bartlett RA, Mulliken JB. Anthropometric study of synostotic frontal plagiocephaly: before and after fronto-orbital advancement with correction of nasal angulation. Plast Reconstr Surg. 2003;112(3):731738.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Isaac KV, MacKinnon S, Dagi LR, Rogers GF, Meara JG, Proctor MR. Nonsyndromic unilateral coronal synostosis: a comparison of fronto-orbital advancement and endoscopic suturectomy. Plast Reconstr Surg. 2019;143(3):838848.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Chan JWH, Stewart CL, Stalder MW, St Hilaire H, McBride L, Moses MH. Endoscope-assisted versus open repair of craniosynostosis: a comparison of perioperative cost and risk. J Craniofac Surg. 2013;24(1):170174.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Tan SPK, Proctor MR, Mulliken JB, Rogers GF. Early frontofacial symmetry after correction of unilateral coronal synostosis: frontoorbital advancement vs endoscopic strip craniectomy and helmet therapy. J Craniofac Surg. 2013;24(4):11901194.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Alford J, Derderian CA, Smartt JM Jr. Surgical treatment of nonsyndromic unicoronal craniosynostosis. J Craniofac Surg. 2018;29(5):11991207.

  • 9

    Becker DB, Fundakowski CE, Govier DP, Deleon VB, Marsh JL, Kane AA. Long-term osseous morphologic outcome of surgically treated unilateral coronal craniosynostosis. Plast Reconstr Surg. 2006;117(3):929935.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Steinbacher DM, Wink J, Bartlett SP. Temporal hollowing following surgical correction of unicoronal synostosis. Plast Reconstr Surg. 2011;128(1):231240.

  • 11

    Pickersgill NA, Skolnick GB, Naidoo SD, Smyth MD, Patel KB. Regression of cephalic index following endoscopic repair of sagittal synostosis. J Neurosurg Pediatr. 2018;23(1):5460.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Taylor JA, Paliga JT, Wes AM, et al. A critical evaluation of long-term aesthetic outcomes of fronto-orbital advancement and cranial vault remodeling in nonsyndromic unicoronal craniosynostosis. Plast Reconstr Surg. 2015;135(1):220231.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Öwall L, Darvann TA, Larsen P, et al. Facial asymmetry in children with unicoronal synostosis who have undergone craniofacial reconstruction in infancy. Cleft Palate Craniofac J. 2016;53(4):385393.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Starr JR, Collett BR, Gaither R, et al. Multicenter study of neurodevelopment in 3-year-old children with and without single-suture craniosynostosis. Arch Pediatr Adolesc Med. 2012;166(6):536542.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Knight SJ, Anderson VA, Spencer-Smith MM, Da Costa AC. Neurodevelopmental outcomes in infants and children with single-suture craniosynostosis: a systematic review. Dev Neuropsychol. 2014;39(3):159186.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Speltz ML, Collett BR, Wallace ER, et al. Intellectual and academic functioning of school-age children with single-suture craniosynostosis. Pediatrics. 2015;135(3):e615e623.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Endriga MC, Kapp-Simon KA. Psychological issues in craniofacial care: state of the art. Cleft Palate Craniofac J. 1999;36(1):311.

  • 18

    Collett BR, Speltz ML. Social-emotional development of infants and young children with orofacial clefts. Infants Young Child. 2006;19(4):262.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Shapiro DN, Waljee J, Ranganathan K, Buchman S, Warschausky S. Using the Patient Reported Outcomes Measurement Information System to evaluate psychosocial functioning among children with craniofacial anomalies. Plast Reconstr Surg. 2015;135(6):16731679.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Volpicelli EJ, Pfaff MJ, Hakimi K, Bradley JP, Solem RC, Lee JC. Age-related differences in psychosocial function of children with craniofacial anomalies. Plast Reconstr Surg. 2017;140(4):776784.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Chang KWC, Austin A, Yeaman J, et al. Health-related quality of life components in children with neonatal brachial plexus palsy: a qualitative study. PM R. 2017;9(4):383391.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Bickham RS, Ranganathan K, Wombacher NR, et al. Speech perceptions and health-related quality of life among children with cleft lip and palate. J Craniofac Surg. 2017;28(5):12641268.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Said AM, Skolnick GB, Girresch Ward S, et al. Using patient reported outcome measures to screen for cognitive function deficits and stigma in patients with single suture craniosynostosis. Plast Reconstr Surg 2021; in press.

    • Search Google Scholar
    • Export Citation
  • 24

    Lo LJ, Marsh JL, Kane AA, Vannier MW. Orbital dysmorphology in unilateral coronal synostosis. Cleft Palate Craniofac J. 1996;33(3):190197.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Pobornikova S. An x-ray investigation of the development of the frontal sinuses in children. Folia Med (Plovdiv). 1974;16(4):213220.

  • 26

    Mesa JM, Fang F, Muraszko KM, Buchman SR. Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique. Neurosurg Focus. 2011;31(2):E4.

  • 27

    Jimenez DF, Barone CM. Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg. 1998;88(1):7781.

  • 28

    Nguyen DC, Farber SJ, Skolnick GB, et al. One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care. J Neurosurg Pediatr. 2017;20(5):410418.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Farkas LG. Anthropometry of the Head and Face. Raven Press;1994.https://books.google.com/books?id=MKVpAAAAMAAJ

  • 30

    Oh AK, Wong J, Ohta E, Rogers GF, Deutsch CK, Mulliken JB. Facial asymmetry in unilateral coronal synostosis: long-term results after fronto-orbital advancement. Plast Reconstr Surg. 2008;121(2):545562.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Skolnick GB, Naidoo SD, Patel KB, Woo AS. Analysis of digital measures of cranial vault asymmetry for assessment of plagiocephaly. J Craniofac Surg. 2014;25(4):11781182.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Rothrock NE, Hays RD, Spritzer K, Yount SE, Riley W, Cella D. Relative to the general US population, chronic diseases are associated with poorer health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol. 2010;63(11):11951204.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33

    Tandon D, Skolnick GB, Naidoo SD, et al. Morphologic severity of craniosynostosis: implications for speech and neurodevelopment. Cleft Palate Craniofac J. 2021;58(11):13611369.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Cooper DC, Peterson EC, Grellner CG, et al. Cleft and craniofacial multidisciplinary team clinic: a look at attrition rates for patients with complete cleft lip and palate and nonsyndromic single-suture craniosynostosis. Cleft Palate Craniofac J. 2019;56(10):12871294.

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 63 63 63
Full Text Views 25 25 25
PDF Downloads 49 49 49
EPUB Downloads 0 0 0