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Does the Bandeau Grow: Quantifying Post-Operative Changes in the Bandeau Over Time after Fronto-orbital Advancement
Lucas A. Dvoracek1, Aaron Foglio1, Sean Herman1, Eva Roy1, Scott P. Bartlett2, Joseph E. Losee1, Jesse A. Taylor,2 Jesse A. Goldstein1
1. Univ. of Pittsburgh, Dept. of Plastic Surgery
2. Univ. of Pennsylvania, Div. of Plastic Surgery
University of Pittsburgh
2019-02-13
Presenter: Lucas Dvoracek
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction
Temporal hollowing is a late sequelae of fronto-orbital advancement (FOA) surgeries. Bony manipulation including devascularization and under-correction may contribute to temporal hollowing. We sought to objectively assess how such bony morphology changes over time.
Methods
A multi-center, retrospective study identified craniosynostosis (CS) patients treated with FOA between 2008-2018 with both early and late (>12 mos) post-operative head CT scans. Scans were reconstructed, oriented, and manually segmented into surgical fragments that delineated the osteotomies of interest for a given patient. 32 data points and 35 discreet metrics were collected from each patient and evaluated for changes over time.
Results
Twenty patients matched inclusion criteria (12 female:8 male). CS subtypes included metopic (7), unilateral coronal (6 right, 3 left), and other (4). Mean age at surgery and time to follow-up scan was 1.4 and 2.8 years respectively. Average biparietal growth was 3.3%. The bandeau AP length increased 18.2%, and height increased 29.5%. While average bandeau bitemporal width increased 4.7%, anterior width decreased by 4.1%, leading to a anterior transverse deficiency. The average initial bandeau orbital width was 3.8mm wider than the midface orbital width and decreased by 2mm (~50% loss of overcorrection). Data was significant by paired t-test.
Conclusion
The long-term shape and position of the bandeau determines surgical success of FOA. We found that the skull continues to widen bitemporally after surgery, however widening at the anterior temporal region is negligible. This is the first comparative demonstration of the bony contribution toward temporal hollowing in early and late post-operative patients.
