New Technique for Reconstructing the Affected Cranium and Orbital Rim in Unicoronal Craniosynostosis

Abstract

Of the single-suture craniosynostoses, unicoronal synostosis (UCS) is widely acknowledged to represent the most varied and complex set of craniofacial deformities. This is attributed to the endocranial base being affected along with the coronal suture. This deformity may present with both coronal and frontosphenoidal synostosis and has been associated with elevated intracranial pressure; brain morphological abnormalities; vertical dystopia; ambylopia; malformations of the forehead, orbit, midface, and mandible; and behavioral, cognitive, and speech abnormalities. It is the variable structural presentation coupled with the long-term stability of the reconstruction that forms a complex reconstructive challenge. Our surgical technique concordantly addresses these associated structures beyond the isolated coronal suture. Although several surgical techniques have previously been described, there remains no consensus toward a preferred surgical approach to this dynamic and three-dimensional problem. We describe our technique of coronal and frontosphenoidal synostosis release as part of a frontotemporoparietal bone flap, release of the entire fronto-orbital rim, and use of the unaffected skull to reconstruct the affected half of the skull. The purpose of our study was to describe our surgical approach to UCS. It has been our experience that optimal correction of UCS must address the associated anomalies beyond the affected coronal suture and must be stable over time.