Facial Asymmetry in Unilateral Coronal Synostosis: Long-Term Results after Fronto-orbital Advancement

Background: Unilateral coronal synostosis causes asymmetry of the forehead and face. The authors set out to document asymmetry and rotation of the middle/lower facial soft tissues using three-dimensional photogrammetry in adolescent and adult patients with unilateral coronal synostosis who underwent correction in infancy. Methods: All patients older than 10 years who had bilateral fronto-orbital advancement in infancy for nonsyndromic unilateral coronal synostosis were eligible for this study. The following paired anthropometric distances were measured: medial canthus to facial midline distance (endocanthion to sellion); middle facial depth (tragion to subnasale); and lower facial depth (tragion to gnathion). Nasal tip deviation (sellion to pronasale) and facial midline deviation (sellion to subnasale to gnathion) were also measured. Results: There were 15 patients with an average age at fronto-orbital advancement of 8 months (range, 3 to 14 months). Three-dimensional digital images were taken at an average age of 14 years (range, 11 to 29 years). Digital anthropometry documented decreased mean middle facial depth (5.1 ± 3.2 mm; p < 0.00001) and lower facial depth (2.7 ± 2.5 mm; p < 0.00001) on the fused side. Average deviation of the nasal tip and facial midline to the nonfused side was 5.0 ± 1.2 degrees and 3.4 ± 0.7 degrees, respectively. All 15 patients exhibited rotation of the middle and lower face to the nonfused side (chi-square analysis, p < 0.0001). Applying the Bonferroni correction, asymmetry did not correlate with age at frontal advancement or age at digital imaging. Conclusion: Adolescents and adults with unilateral coronal synostosis who underwent fronto-orbital advancement in infancy have consistent middle and lower facial asymmetry.

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