Long-term results following fronto-orbital reconstruction in nonsyndromic unicoronal synostosis.
BACKGROUND
Fronto-orbital reconstruction is the standard of care for repair of unilateral coronal synostosis. This study examined the relationship between age at initial surgery and need for secondary surgery, to determine the optimal age for reconstruction.


METHODS
The series comprised 81 patients with unicoronal synostosis who underwent reconstruction over a 30-year period by a single surgeon. Measured outcomes included reoperation rate, relapse/defect rate, relapse interval, and problem rate.


RESULTS
Average age at surgery was 11.3 months (range, 1.5 to 71 months). The problem rate was 27.2 percent. Mean follow-up was 69 months (range, 6 to 234 months). The postoperative defect rate was 73 percent. Sixteen patients (20 percent) underwent reoperation to correct secondary deformities. Whitaker category I or II results were achieved in 90.1 percent. Problem rates for patients aged 0 to 6 months, 6 to 12 months, and older than 12 months were 13.3, 28, and 35, respectively. Secondary surgery was performed in 40 percent of patients whose first surgery was at 0 to 6 months, 7 percent aged 6 to 12 months, and 30.4 percent older than 12 months. After surgery, 87 percent of patients aged 0 to 6 months, 95 percent aged 6 to 12 months, and 87 percent older than 12 months had Whitaker category I or II results.


CONCLUSIONS
Fronto-orbital advancement at younger than 6 months had the highest incidence of readvancement. Patients treated at 6 to 12 months had the least need for any secondary surgery; however, patients older than 12 months had the lowest incidence of readvancement. These results indicate that fronto-orbital advancement should be delayed until at least age 6 months to avoid relapse.
Selber
Jesse Creed
JC
Philadelphia, Pa.; and Hollywood and Tampa, Fla. From the Division of Plastic Surgery and Department of Surgery, Hospital of the University of Pennsylvania, and the Children's Hospital of Philadelphia; private practice; and the Department of Surgery, University of South Florida.
Brooks
Christopher
C
Kurichi
Jibby E
JE
Temmen
Traci
T
Sonnad
Seema S
SS
Whitaker
Linton A
LA
D000367:Age Factors; D001860:Bone Plates; D001864:Bone Wires; D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D009915:Orbit / Q000002:abnormalities* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012737:Sex Factors