The Evolution of Unicoronal Synostosis Correction: Long-Term Aesthetic Outcomes of Fronto-Orbital Distraction Versus Traditional Advancement.

Abstract

This study compares the long-term aesthetic outcomes of patients with unicoronal synostosis (UCS) who underwent fronto-orbital distraction osteogenesis (FODO) versus traditional fronto-orbital advancement and remodeling (FOAR). Patients treated for nonsyndromic UCS from 2009 to 2023 were retrospectively reviewed. Perioperative and complication characteristics were compared between all patients who underwent FOAR, open FODO, and endoscopic-assisted FODO ("endo-FODO"). Aesthetic outcomes at greater than five years postoperatively were compared between patients who underwent FODO and a contemporaneous cohort of age-matched controls who underwent FOAR. Differences between pre- and postoperative periorbital symmetry ratios, canthal tilt symmetry, orbital dystopia angle (ODA), and frontal bossing angle were calculated, with positive differences representing postoperative improvement. Forty-one patients were treated at a median age of 9.7, 5.4, and 5.4 months in the FOAR, open FODO, and endo-FODO groups, respectively. Among 28 patients photographed at a median of 6.3 years postoperatively, the FODO cohort demonstrated greater margin-to-reflex distance 1 symmetry (6.5 [-9.3, 0.0] vs. -13.9 [-22.9, -11.5], p=0.010) and canthal tilt symmetry (0.9° [0.2°, 2.9°] vs. 3.3° [2.3°, 5.3°], p=0.004) postoperatively as well as ODA correction (5.4° [4.0°, 7.5°] vs. 3.0° [2.5°, 4.4°], p=0.027) compared to the FOAR cohort. Fewer patients in the FODO cohort exhibited temporal hollowing postoperatively compared to the FOAR cohort (14% vs. 71%, p=0.002). Compared to FOAR, FODO was associated with greater periorbital symmetry, greater orbital dystopia correction, and reduced temporal hollowing in the long-term. Follow-up to cranial maturity is needed to adequately compare the two techniques.