Evolution of Cranioorbital Shape in Nonsyndromic, Muenke, and Saethre-Chotzen Bilateral Coronal Synostosis: A Case-Control Study of 2-Year Outcomes

Craniometric and Aesthetic Outcomes in Craniosynostosis Surgery: A Systematic Review and Meta-Analysis

ObjectiveTo systematically review the published comparative aesthetic outcomes, and its determinants, for craniosynostoses surgically treated by minimally-invasive cranial procedures and open cranial vault remodeling (CVR).DesignPRISMA-compliant systematic review.SettingNot-applicable.Patients/ParticipantsArticles were included if they compared spring cranioplasty, strip minimally-invasive craniectomy or CVR for outcomes related to aesthetics or head shape. Forty-two studies were included, comprising 2402 patients.InterventionsNone.Main Outcome Measure(s)The craniometric and PROM used to determine surgical outcomes.ResultsTwenty-five studies (59%) evaluated sagittal craniosynostosis, with metopic (7;17%) and unicoronal (4;10%) the next most prevalent. Thirty-eight studies (90%) included CVR, 24 (57%) included strip craniectomy with helmeting, 9 (22%) included strip craniectomy without helmeting, 11 (26%) included spring cranioplasty, and 3 (7%) included vault distraction. A majority of studies only used 1 (43%) or 2 (14%) craniometric measures to compare techniques. In sagittal synostosis, 13 (59%) studies showed no difference in craniometric outcomes, 5 (23%) showed better results with CVR, 3 (14%) with strip craniectomy, and 1 (5%) with springs. In studies describing other synostoses, 10/14 (71%) were equivocal. Subjective outcome measures followed similar trends. Meta-analysis shows no significant difference in cranial index (CI) outcomes between CVR and less invasive procedures in patients with sagittal synostosis.ConclusionsThere is no difference in CI outcomes between CVR and less invasive procedures. The majority of literature comparing craniometric and aesthetic outcomes between CVR and less invasive procedures shows equivocal results for sagittal synostosis. However, the heterogeneity of data for other craniosynostoses did not allow meta-analysis.

Craniosynostosis: Current Evaluation and Management

ABSTRACT

Craniosynostosis is characterized by the premature fusion of one or more cranial sutures, which can lead to abnormal skull shape and restricted skull growth. Although most cases are present in isolation, some are associated with genetic syndromes, such as Pfeiffer, Muenke, Couzon, Apert, and others, which increases the complexity of care. Today, a spectrum of surgical options to treat craniosynostosis are available and range from traditional open cranial vault remodeling to newer and less invasive suturectomy-based techniques. Which procedure is offered to a patient depends on not only the specific synostosis pattern but also factors such as patient age, the need for additional procedures or interventions, and evidence of elevated intracranial pressure. Thorough consultations with families to discuss achievable goals for cosmesis and function are essential in providing optimal care to each impacted child.

Alterations in Sphenoid Anatomy in Craniosynostosis: Implications for Fronto-Orbital Advancement

OBJECTIVE

Fronto-orbital advancement involves removal of the fronto-orbital bandeau. Visualization of the saw blade is lost as it passes through the fronto-orbital-sphenoid junction (FOSJ), placing the temporal lobe at risk of injury. We aim to provide a 3D analysis of the space surrounding this osteotomy to differentiate various types of craniosynostoses.

DESIGN

Retrospective cohort.

SETTING

Institutional.

PATIENTS

Thirty patients with isolated unicoronal synostosis, nonsyndromic bicoronal synostosis, metopic synostosis, Apert syndrome, Crouzon syndrome, and Muenke syndrome.

INTERVENTIONS

CT scans conducted between 2 months to 2 years of age were 3D reconstructed to compare craniometrics against normal controls.

MAIN OUTCOME MEASURE(S)

Craniometrics.

RESULTS

The mean bone thickness of the FOSJ at the level of the supraorbital rim was significantly small for the Apert, unicoronal and bicoronal groups. The mean vertical height of the middle cranial fossa from the lesser sphenoid wing was significantly greater in the unicoronal group. The mean vertical height of the tip of the temporal lobe from the lateral sphenoid ridge was greater in the unicoronal, isolated bicoronal, and Apert groups. The mean corneal protrusion beyond the lateral orbital rim was significantly greater in the Apert and unicoronal groups. The mean horizontal depth of the orbit was smallest in the Apert group. The mean vertical distance between the dacryon and the foramen cecum, and the mean volume of temporal lobe beneath the sphenoid shelf were the largest in the Apert group.

CONCLUSIONS

Patients with Apert syndrome have the most unfavorable morphology of the anterior and middle cranial fossae.

Patient-Specific Implants and Fat Grafting for Contour Deformities Post Craniosynostosis Reconstruction: A Therapeutic Approach

BACKGROUND

Contour deformities after fronto-orbital advancement for craniosynostosis reconstruction are commonly encountered. There is a paucity of literature describing secondary procedures to correct such deformities with reported outcomes. An approach to defect analysis and procedure selection is lacking. The authors present our experience utilizing fat grafting (FG) and patient-specific implant (PSI) reconstruction as management strategies for this population.

METHODS

A retrospective analysis of consecutive patients who underwent secondary onlay PSI or FG for contour deformities after primary craniosynostosis reconstruction was carried out. Patient demographics, defect analysis, surgical approach, postoperative complications, and esthetic outcomes were recorded. Data were pooled across the entire cohort and presented in a descriptive manner.

RESULTS

Fourteen patients (36% syndromic and 64% isolated) were identified that either underwent PSI (n = 7) with a mean follow-up of 56.3 weeks, FG (n = 5) with a mean follow-up of 36 weeks or a combination of both (n = 2) for deformities postcraniosynostis surgery. Supraorbital retrusion and bitemporal hollowing were the most common deformities. There were no intraoperative or postoperative complications. All patients achieved Whitaker class I esthetic outcomes and there were no additional revisions during the defined study period. The presence of a significant structural component or large (>5 mm) depression typically necessitated a PSI.

CONCLUSIONS

Contour deformities after fronto-orbital advancement reconstruction can be successfully managed using FG and PSI either as a combination procedure or in isolation. The authors have proposed anatomical criteria based on our experience to help guide procedure selection. Future prospective studies would be beneficial in providing more objective assessment criteria.

Syndromic Craniosynostosis: Cranial Vault Expansion in Infancy

Syndromic craniosynostosis (CS) represents a relatively uncommon disease process that poses significant reconstructive challenges for the craniofacial surgeon. Although there is considerable overlap in clinical features associated with various forms of syndromic CS, key extracranial features and close examination of the extremities help to distinguish the subtypes. While Virchow's law can easily guide the diagnosis of single suture, nonsyndromic CS, syndromic CS traditionally results in atypical presentations inherent to multiple suture fusion. Coronal ring involvement in isolation or associated with additional suture fusion is the most common pattern in syndromic CS often resulting in turribrachycephaly.