title: A critical evaluation of long-term aesthetic outcomes of fronto-orbital advancement and cranial vault remodeling in nonsyndromic unicoronal craniosynostosis.
abstract: BACKGROUND
  This study reports long-term aesthetic outcomes with fronto-orbital advancement and cranial vault remodeling in treating unicoronal synostosis over a 35-year period.
  
  
  METHODS
  Retrospective review was performed on patients with isolated unicoronal synostosis from 1977 to 2012. Demographic, preoperative phenotypic, and long-term aesthetic outcomes data were analyzed with chi-squared and Fisher's exact test for categorical data and Wilcoxon rank-sum and Kruskal-Wallis rank for continuous data.
  
  
  RESULTS
  A total of 238 patients were treated; 207 met inclusion criteria. None underwent secondary intervention for intracranial pressure. At definitive intervention, there 96 (55 percent) Whitaker class I patients, 11 (6 percent) class II, 62 (35 percent) class III, and six (3 percent) class IV. Nasal root deviation and occipital bossing each conferred an increased risk of Whitaker class III/IV [OR, 4.4 (1.4 to 13.9), p = 0.011; OR, 2.6 (1.0 to 6.8), p = 0.049]. Patients who underwent bilateral cranial vault remodeling with extended unilateral bandeau were less likely Whitaker class III/IV at latest follow-up compared with those undergoing strictly unilateral procedures [OR, 0.2 (0.1 to 0.7), p = 0.011]. Overcorrection resulted in decreased risk of temporal hollowing [OR, 0.3 (0.1 to 1.0), p = 0.05]. Patients with 5 years or more of follow-up were more likely to develop supraorbital retrusion [OR, 7.2 (2.2 to 23.4), p = 0.001] and temporal hollowing [OR, 3.7 (1.5 to 9.6), p = 0.006] and have Whitaker class III/IV outcomes [OR, 4.9 (1.8 to 12.8), p = 0.001].
  
  
  CONCLUSIONS
  Traditional fronto-orbital advancement and cranial vault remodeling appears to mitigate risk of intracranial pressure but may lead to aesthetic shortcomings as patients mature, namely fronto-orbital retrusion and temporal hollowing.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Philadelphia, Pa. From the Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, and The Children's Hospital of Philadelphia.
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Taylor
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Paliga
authors.forename: Ari M
authors.initials: AM
authors.lastname: Wes
authors.forename: Youssef
authors.initials: Y
authors.lastname: Tahiri
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Goldstein
authors.forename: Linton A
authors.initials: LA
authors.lastname: Whitaker
authors.forename: Scott P
authors.initials: SP
authors.lastname: Bartlett
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005624:Frontal Bone / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D009915:Orbit / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods*; D063868:Patient Outcome Assessment; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult