Assessing Facial Asymmetry in Postoperative Patients With Unilateral Coronal Craniosynostosis. Issue 4 (June 2020)

• Record Type: Journal Article
• Authors: Gabrick, Kyle S.; Wu, Robin T.; Singh, Anusha; Bartlett, Scott P.; Taylor, Jesse A.; Persing, John A.; Alperovich, Michael
• Is Part Of: Journal of craniofacial surgery. Volume 31:Issue 4(2020)
• Publication Date: 2020-06
• Subjects: Facial asymmetry -- long-term outcomes -- unilateral coronal craniosynostosis; Facial bones -- Surgery -- Periodicals; Skull -- Surgery -- Periodicals; Face -- Surgery -- Periodicals; Surgery, Plastic -- Periodicals; 617.52
• DOI: 10.1097/SCS.0000000000006355
• Languages: English
• ISSNs: 1049-2275

Abstract

Abstract : Background: Despite surgical correction of unilateral craniosynostosis (ULC), complex cranial base angulation can result in partial reversion to preoperative deformity with growth and time. Using 3-dimensional imaging, dysmorphic facial features of ULC in school-age patients were quantified and related to how they contribute to overall facial asymmetry and patient-reported outcomes. Methods: Children who underwent surgical correction of ULC were recruited from Yale University and Children's Hospital of Philadelphia. The 3D photographs were analyzed utilizing a Procrustes analysis of shape. Pearson's correlation was used to determine dysmorphic features' impact on overall asymmetry. Patients were stratified into "moderate" and "severe" asymmetry. Finally, asymmetry was correlated to patient-reported outcome scores. Statistical analysis was performed with SPSS-25 with P < 0.05 as statistically significant. Results: Twenty-one patients were included with average age at analysis of 12.3 years. Fifty-seven percent of patients had right-sided fusion. The overall Procrustes analysis indicated a root mean square difference of 2.21 mm. Pearson's correlation indicated that the facial middle 3rd ( P ⩽ 0.001), orbital dystopia ( P < 0.001), chin point deviation ( P = 0.011), and nasal root angulation ( P = 0.019) contributed most to overall asymmetry. Patients in the severe asymmetry cohort had greater facial middle-third asymmetry ( P < 0.001) and orbital dystopia ( P < 0.001). Asymmetry did not correlate with patient-reported outcomes. Conclusion: Patients with ULC have persistent facial asymmetry at school-age with the greatest levels of asymmetry in the facial middle-third, orbit, and nasal root. Beyond the cranial dysmorphology, initial skull base angulation in unilateral coronal craniosynostosis manifests in long-term mid and lower-third facial asymmetry. Abstract : Supplemental Digital Content is available in the text