Treatment of unilateral coronal synostosis by fronto-orbital advancement with simple tenon forming fixation

Abstract

Objective To summarize the experiences of treating unilateral coronal synostosis (UCS) by fronto-orbital advancement with simple tenon forming fixation. Methods We retrospectively analyzed UCS children undergoing fronto-orbital advancement with simple tenon forming fixation from September 2014 to December 2015.The skull morphological changes of cephalic index (CI), cranial vault asymmetry index (CVAI), anterior cranial vault asymmetry index (ACVAI) and posterior cranial vault asymmetry index (PCVAI) before and after surgery were analyzed by 3-dimensionl remodeling software (Mimics 10.01 & Magics 19.0.1). The follow-up results were collected to summarize the experiences of treatment. Results A total of 6 cases with unilateral coronal synostosis were recruited.There were 1 boy and 5 girls with an age range of 5 to 17 months.The involved sides were left (n=2) and right (n=4). Two had concurrent high intracranial pressure (ICP). The preoperative CI values were greater than 85% with an average of 95.4%±8.9%.And CVAI, ACVAI and PCVAI were increased by an average of 10.1%±7.4%, 17.1%±7.1% and 7.5%±6.1% respectively.Skull deformation was severe in 2 ICP children: CI>100%, CVAI>18.7%, ACVAI>20% and PCVAI>14%.The postoperative values of CI, CVAI, ACVAI and PCVAI were 92.7%±8.1%, 3.7%±4.0%, 6.6%±3.2% and 5.2%±3.5% respectively.As compared with preoperative values, improvements had significant differences (P<0.05). Except for 3 cases of blood transfusion due to anemia, there was no onset of such serious complications as cerebrospinal fluid leakage, intracranial infection or scalp necrosis.During a follow-up period of 6-12 months, appearance was satisfactory without recurrence or osseous flap transposition. Conclusions Unilateral coronal synostosis may be successfully managed by fronto-orbital advancement with simple tenon forming fixation.With a lower operative difficulty and better fixation stability, it has excellent short-term clinical outcomes.However, the long-term effects on brain development and craniofacial appearance require further investigations. Key words: Craniosynostosis; Coronal suture; Osseous flap