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

Abstract

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. 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. 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. Adolescents and adults with unilateral coronal synostosis who underwent fronto-orbital advancement in infancy have consistent middle and lower facial asymmetry.