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Impact of Fronto-Orbital Advancement on Frontal Sinus Morphology and Disease in Craniosynostosis
Wen Xu, BS, Jing Li, MD, Patrick Gerety, MD, Daniel Mazzaferro, MBA, Scott Bartlett, MD, Jesse Taylor, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.

INTRODUCTION: Fronto-orbital advancement (FOAR) potentially injures frontal sinus buds, leading to poor pneumatization and rhinosinusitis. This study aims to measure frontal sinus volume and incidence of sinusitis in craniosynostosis patients who have undergone FOAR, and to compare them to controls.
METHODS: We conducted a retrospective review of all craniosynostosis patients treated with FOAR in infancy at our craniofacial center. Frontal sinus morphology and volume were assessed with Mimics®. Sinus disease was defined as mucosal thickening or sinus fluid. Unaffected age-matched controls were identified from a facial trauma database.
RESULTS: We included 100 craniosynostosis and control subjects. Demographic and surgical data are shown in Table 1. The rate of frontal sinus pneumatization was 81% in syndromic craniosynostosis, 94% in non-syndromic craniosynostosis (NSC), and 95% in control subjects (p=0.172). Average volume was 4.46cc in syndromic craniosynostosis, 4.13cc in NSC, and 4.38cc in control subjects (p=0.9311), and was significantly correlated with age at which CT was performed (p=0.0034). Pneumatization rates and volume did not significantly correlate with age of initial FOAR, number of frontal surgeries, or age at most recent surgery. Evidence of frontal sinus disease was highest in the syndromic group (p=0.002), with three syndromic patients requiring surgical intervention for frontal sinus disease.
CONCLUSION: While syndromic patients demonstrated lower pneumatization rates and higher sinus disease rates, FOAR does not significantly impact frontal sinus development and pathology.
Table 1
Control
(n=20)
Non-syndromic craniosynostosis (n=33)Syndromic craniosynostosis (n=47)P Value
Age at time of CT scan (years)13.81 ± 2.913.00 ± 2.513.94 ± 3.70.4131
Male16 (80.0%)15 (45.5%)26 (55.3%)0.046*
Number of FOAs-1.00 ± 0.01.62 ± 0.7<0.00005*
Number of frontal surgeries-1.00 ± 0.02.19 ± 0.9<0.00005*
Age at initial frontal surgery (years)-0.80 ± 0.31.22 ± 1.10.0921
Age at most recent frontal surgery (years)-0.80 ± 0.37.75 ± 5.1<0.00005*
Time between most recent frontal surgery and CT scan (years)-12.2 ± 2.46.2 ± 4.7<0.00005*
Pneumatization rate19 (95.0%)31 (93.9%)38 (80.9%)0.172
Qualitative description of frontal sinus0.123
Bilateral (symmetric)12 (60.0%)15 (45.5%)24 (51.1%)
Bilateral (asymmetric)6 (30.0%)12 (36.4%)7 (14.9%)
Unilateral1 (5.0%)4 (12.1%)4 (8.5%)
Small midline sinus0 (0.0%)0 (0.0%)3 (6.3%)
Absent1 (5.0%)2 (6.1%)9 (19.1%)
Volume (cc)4.38 ± 3.954.13 ± 2.754.46 ± 4.050.9311
Maximum width (mm)41.3 ± 14.344.4 ± 13.543.0 ± 15.50.7647
Maximum depth (mm)21.9 ± 5.522.7 ± 5.823.3 ± 6.70.7152
Maximum height (mm)25.2 ± 7.423.9 ± 6.920.3 ± 9.30.058
Clinical sinus disease2 (10.5%)3 (10.0%)5 (14.3%)0.482
Frontal sinus disease on CT scan0 (0.0%)1 (3.0%)12 (25.5%)0.002*
Surgical intervention for sinus disease0 (0.0%)0 (0.0%)3 (6.4%)0.3


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