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EVALUATION OF LATERAL BROW STABILITY FOLLOWING SINGLE SUTURE SYNOSTOSIS REPAIR
Richard A. Hopper, MD, Craig Birgfeld, MD, David Khetchoyan, MD, Jennifer Brown, BS.
University of Washington, Seattle, WA, USA.
One goal of the surgery for metopic synostosis (MS) and unicoronal synostosis (UCS) is to advance the lateral brow relative to the central forehead. The purpose of this study was to use a quantitative ratio analysis based on CT data to determine whether pre-operative severity or post-operative correction were related to brow shape after two years.
We retrospectively examined 32 consecutive patients with MS and 24 patients with UCS following primary surgery (age range: 8-15 months; 2002-2007). All patients had CT scans pre-operation, immediately post-operation, and at two years follow-up. Digital analysis was used to measure central and lateral brow position relative to skull base. A Central Forehead Prominence (CFP) ratio was used as a measure of trigonocephaly from MS, and a Unilateral Coronal Ratio (UR, figure 1) for plagiocephaly from UCS. Both measures used standardized trigometric areas to compare lateral brow position and shape relative to the central forehead (CFP) or to the contralateral brow (UR). The relationship between 2 year symmetry measures and pre-operation and post-operation measures was examined using Linear Regression analysis for each group.
Relative lateral brow position and shape at two years after operation was more strongly associated with immediate post-operative correction than it was to pre-operative degree of deformity for patients with MS (p-0.0012). In contrast, with UCS, the two year result was more related to the pre-operative deformity than the immediate post-operative result (p<0.001).
In patients with MS, the brow position after two years was more impacted by the result achieved during the surgery, than by the degree of pre-operative deformity. In contrast, despite appropriate surgical expansion, in patients with UCS, the nature of the pre-operative deformity can be the major determining factor in eventual outcome. Patients with severe UCS deformity should be informed of this relationship to align expectations with outcome.
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