title: Critical analysis of results of craniofacial surgery for nonsyndromic bicoronal synostosis.
abstract: We retrospectively assessed the intermediate and long-term results of craniofacial surgery in 22 consecutive patients with nonsyndromic bicoronal synostosis to determine the outcome of corrective surgery. The study population consisted of 13 males and 9 females whose ages ranged from 6 weeks to 24 months (mean, 5.6 months) at the time of initial surgery. All patients had been assigned a diagnosis of nonsyndromic bicoronal synostosis. Each patient underwent resection of both coronal sutures and frontal orbital advancement with cranial vault remodeling using a floating forehead technique. Age at initial operation was 5 months or less in 13 patients and 6 months or more in 9. Complications occurred in 5 patients (23%), and 1 patient with an associated metabolic disorder died from respiratory arrest postoperatively. Follow-up ranged from 6 to 168 months (mean, 53.2 months). Results were graded according to the need for and extent of reoperation. Residual aesthetic deformities were documented in 12 patients (55%). Three patients (14%) required calvarial recontouring or cranioplasty to achieve satisfactory forehead contour or bony continuity. Total reoperation for recurrent deformity was required at a mean age of 29.7 months in 8 patients (36%) and is pending in another (4%). Four patients (18%) required a third operation (two total reoperations and two cranioplasties) to achieve satisfactory results. Eight of 13 patients (62%) operated on at 5 months of age or younger required total reoperation compared with 1 of 9 (11%) operated at 6 months of age or older. When analyzed alone, age of operation was a statistically significant determinant of the need for reoperation (p < 0.03). However, when subjected to multivariate analysis, neither age at operation nor the presence of an associated anomaly or positive family history had a significant effect on outcome.
authors.affiliation: University of Michigan Craniofacial Anomalies Program, Ann Arbor, MI, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Wagner
authors.forename: S R
authors.initials: SR
authors.lastname: Cohen
authors.forename: H
authors.initials: H
authors.lastname: Maher
authors.forename: R C
authors.initials: RC
authors.lastname: Dauser
authors.forename: M H
authors.initials: MH
authors.lastname: Newman
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D003394:Craniofacial Dysostosis / Q000209:etiology / Q000601:surgery; D003398:Craniosynostoses / Q000209:etiology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome