A Cohort Study of Strabismus Rates Following Correction of the Unicoronal Craniosynostosis Deformity: Conventional Bilateral Fronto-Orbital Advancement Versus Fronto-Orbital Distraction Osteogenesis

Abstract

Background:The purpose of this prospective study is to compare perioperative morbidity and strabismus rates between traditional fronto-orbital advancement reconstruction (FOAR) and frontoorbital distraction osteogenesis (FODO) in unicoronal craniosynostosis (UCS). Method: A consecutive group of 15 patients undergoing FODO for isolated UCS were compared to a contemporaneous group of 15 patients undergoing traditional FOAR for UCS. Patient age, operative time, blood loss, blood replacement, technical details of the surgery, length of stay, complications, and strabismus rates were documented and compared statistically using chi-square and Student t test with a significance value of 0.05. Results: The 15 patients undergoing FODO were younger (6.3 and 9.8 months, P < 0.05), experienced less operative time for the initial procedure (111 versus 190 minutes, P < 0.01), less blood loss (26% versus 50% of total blood volume, P < 0.01), and less blood replacement (40% versus 60% of total blood volume, P < 0.05). One patient in the FODO group experienced a new-onset strabismus postoperatively compared with 5 in the FOAR group (P < 0.05). There were no complications requiring a return to the operating room in either group. Conclusions: Fronto-orbital distraction osteogenesis for the treatment of isolated UCS is associated with a favorable perioperative morbidity profile and a decreased incidence of postoperative strabismus compared with traditional FOAR. These positive factors are tempered by the need for an additional procedure for removal of the device and lack of long-term outcomes data on the technique.

Isolated Frontosphenoidal Synostosis: Early Clinical Management of a Rare Condition With Distraction Osteogenesis

“…Additionally, this approach is linked to significantly higher rates of strabismus compared to the distraction osteogenesis approach. 20,21 Distraction osteogenesis (DO) typically takes place within 3 to 6 months of age. The desired time course varies among patients and is dependent upon adequate expansion of the cranial bones.…”

“…Additionally, this approach is linked to significantly higher rates of strabismus compared to the distraction osteogenesis approach. 20,21…”

Improved Facial and Skull-base Symmetry Following Osteotomy and Distraction of Unilateral Coronal Synostosis

“…Plastic and Reconstructive Surgery • February 2024 and increased intracranial pressure. [8][9][10][11] Although UCS normally appears in isolation, it can also present as part of a craniofacial syndrome. [12][13][14] Surgical correction of UCS is challenging because of its extensive range of deformities.…”

“…To date, case series have presented favorable results in terms of aesthetics, morbidity, and strabismus. 10,22 Moreover, reports suggest that alterations of the skull base in response to the distraction are important to the surgical outcome. 28,30 Previous studies describe various ways to evaluate UCS treatment, ranging from pure aesthetic evaluation to ocular evaluation and asymmetry assessment according to three-dimensional models.…”

“…2–7 The functional consequences of UCS can include strabismus, amblyopia, and astigmatism, and increased intracranial pressure. 8–11 Although UCS normally appears in isolation, it can also present as part of a craniofacial syndrome. 12–14…”