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Objective Analysis of Fronto-Orbital Morphology in Unilateral Coronal Craniosynostosis: A Basis for a Novel Overcorrection Technique
Aaron Foglio, Lucas A. Dvoracek, Michael R. Bykowski, Ali Ayyash, Joseph E. Losee, Jesse A. Goldstein
University of Pittsburgh
2019-02-13
Presenter: Aaron Foglio
Affidavit:
I certify that the work on this project represents the original work of the authors.
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Correction (and over-correction) of asymmetries of the orbital shape and brow position in unilateral coronal craniosynostosis (UCS) is critical to successful fronto-orbital advancement. Here we quantify and three-dimensionally assess fronto-orbital irregularities in UCS patients compared to controls and describe our surgical technique for correction.Twenty-three patients with UCS evaluated at the Children's Hospital of Pittsburgh between 2006 and 2016 were age and gender-matched to controls. CT scans were reconstructed and evaluated. A 3-D heat map of orbital regions was generated to identify shape differences. Brow protrusion of the orbit ipsilateral to the synostotic suture did not differ significantly from healthy controls. Orbital height was significantly increased while orbital width was decreased on the UCS ipsilateral side compared to the contralateral side and controls. The contralateral orbit had increased brow protrusion with decreased orbital height. The cornea was underprojected relative to the brow, but overprojected relative to the lateral orbital rim and similar to controls at the infraorbital rim. 3-D comparison demonstrated significant overprojection of the contralateral brow, with some more mild and inconsistent underprojection of the lateral aspect of the ipsilateral brow. The orbital and brow irregularities in UCS are unique and vary by location and laterality. The ipsilateral brow retrusion is the most notable deformity. Correction of these deformities at our institution includes creation of a three-quarters bandeau, anterior bandeau tilt, ipsilateral bandeau lateralization and ipsilateral coronal plane inferior rotation.
