title: Facial changes after early treatment of unilateral coronal synostosis question the necessity of primary nasal osteotomy.
abstract: BACKGROUND
  The premature fusion of unilateral coronal suture can cause a significant asymmetry of the craniofacial skeleton, with an oblique deviation of the cranial base that negatively impacts soft tissue facial symmetry. The purpose of this study was to assess facial symmetry obtained in patients with unilateral coronal synostosis (UCS) surgically treated by 2 different techniques. We hypothesized that nasal deviation should not be addressed in a primary surgical correction of UCS.
  
  
  METHODS
  Consecutive UCS patients were enrolled in a prospective study and randomly divided into 2 groups. In group 1, the patients underwent total frontal reconstruction and transferring of onlay bone grafts to the recessive superior orbital rim (n = 7), and in group 2, the patients underwent total frontal reconstruction and unilateral fronto-orbital advancement (n = 5). Computerized photogrammetric analysis measured vertical and horizontal axis of the nose and the orbital globe in the preoperative and postoperative periods. Intragroup and intergroup comparisons were performed.
  
  
  RESULTS
  Intragroup preoperative and postoperative comparisons showed a significant (all P < 0.05) reduction of the nasal axis and the orbital-globe axis in the postoperative period in the 2 groups. Intergroup comparisons showed no significant difference (all P > 0.05).
  
  
  CONCLUSIONS
  Facial symmetry was achieved in the patients with UCS who underwent surgery regardless of surgical approach evaluated here. Our data showed a significant improvement in nasal and orbital-globe deviation, leading us to question the necessity of primary nasal correction in these patients.
authors.affiliation: From the *Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital; and †Pediatric Neurosurgical Division, Department of Neurology, School of Medical Sciences, UNICAMP, Campinas, São Paulo, Brazil.
authors.forename: Cassio Eduardo
authors.initials: CE
authors.lastname: Raposo-Amaral
authors.forename: Rafael
authors.initials: R
authors.lastname: Denadai
authors.forename: Enrico
authors.initials: E
authors.lastname: Ghizoni
authors.forename: Celso Luiz
authors.initials: CL
authors.lastname: Buzzo
authors.forename: Cesar Augusto
authors.initials: CA
authors.lastname: Raposo-Amaral
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016025:Bone Transplantation; D003393:Cranial Sutures / Q000601:surgery; D003398:Craniosynostoses / Q000150:complications / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D005146:Facial Asymmetry / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D009666:Nose / Q000601:surgery; D009915:Orbit / Q000601:surgery; D010027:Osteotomy / Q000379:methods / Q000706:statistics & numerical data; D010780:Photogrammetry; D019651:Plastic Surgery Procedures / Q000379:methods / Q000706:statistics & numerical data; D011184:Postoperative Period; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D019564:Unnecessary Procedures