Background: There is a need for a new, less invasive surgical option for unicoronal synostosis (UCS). The aim of this study was to compare the resulting morphology and symmetry in patients with UCS following fronto-orbital distraction (FOD) or calvarial switch (CS).
Methods: 79 patients with isolated UCS operated between 2005 and 2021 were analyzed. Follow-up was until 3 years of age. Angles describing orbital dystopia (ODA) and the anterior cranial fossa deviation and cant (ACFD and ACFC, respectively) were measured. Key linear dimensions, cranial cavities, and indices were calculated.
Results: 66 patients were included (14 in the FOD group and 52 in the CS group). The 3-year follow-up revealed significant improvement in all angles in both groups, with significant superiority in ODA correction following FOD (median improvement of 5.7 degrees as compared with 3.3 degrees after CS). Additionally, nasal and orbital volumes tended to be smaller, especially following CS; however, FOD resulted in a smaller absolute difference in orbital volume. Asymmetry in the orbital, nasal, and sphenoid regions also improved at the 3-year follow-up in both groups, although FOD resulted in complete normalization of the affected orbital shape and significantly improved overall asymmetry relative to that observed in the CS group.
Conclusions: This study found that FOD achieves superior overall symmetry, as well as better shape correction of the cranium, as compared with CS, while also being less invasive. These findings suggest FOD as a safe and effective alternative to correct UCS and possibly the preferred surgical method.
Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.