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Restoration of Nasal Symmetry in Patients with Unilateral Coronal Craniosynostosis
Kyle J. Chepla MD
Arun K. Gosain MD
University Hospitals - Case Medical Center. Cleveland, OH
2012-01-30
Presenter: Kyle J. Chepla
Affidavit:
This work has not been previously published in any form and is entirely the work of the resident.
Director Name: Bahman Guyuron
Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
This presentation addresses objectives 1 and 3. This new technique developed by the senior author is useful for any pediatric or adult craniomaxillofacial surgery and can correct any deviation of the nasal radix whether congenital or traumatic.
How will your presentation be used by practicing physicians in the audience?
This presentation will be useful for any craniomaxillofacial surgeons in attendance who treat patients with congenital or traumatic facial asymmetry of the nasal radix.
Unilateral coronal synostosis (UCS) results in cranial vault asymmetry and ipsilateral deviation of the nasal radix. Surgical treatment of UCS releases the synostotic suture and remodels the frontal cranial skeleton but fails to address nasal root deviation, which remains a source of facial disfigurement. The present report describes a technique to restore nasal symmetry in UCS.
Since 2007 the senior author (AKG) has incorporated additional subperiosteal dissection of the nasal bones, lateral nasal osteotomies, and a transverse osteotomy across the nasion to free the nasal bones. This technique has evolved from complete release of the soft tissue envelope and upper lateral cartilages with ex vivo repositioning to an in situ approach where soft tissue dissection is limited, leaving the "keystone" area intact, to maintain vascularity and anatomic stability. The supraorbital bandeau is then repositioned and the radix is moved to the new midline and secured with 28-gauge wire.
Seven patients (age 9 months to 15 years) have been treated using this technique with excellent immediate results. Repositioning was performed in five patients at the time of cranial vault remodeling (age 9-12 months), and in two patients at secondary cranioplasty (age 3-15 years). Six patients have been followed for over 6 months (7-48 months) and have demonstrated stable outcomes on physical exam and follow-up CT scan. One patient developed a subgaleal infection requiring surgical debridement and late bone grafting. There were no other complications. We now routinely perform this technique for all patients undergoing surgical correction of UCS at our institution.
