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Long-term Outcomes Of Two Fronto-orbital Advancement And Remodeling Techniques In Metopic Craniosynostosis: A 33-year Single-institution Experience
Allison C. Hu, MD, Philip Tolley, MD, Aaron T. Zhao, BS, Dominic J. Romeo, MA, Carrie Z. Morales, MD, Nicholas A. Han, BSE, Isabel A. Ryan, BS, Jordan W. Swanson, MD, Scott P. Bartlett, MD, Jesse A. Taylor, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
PURPOSE: To better expand the anterior cranial fossa and account for growth and relapse after traditional front-orbital advancement (FOA), an intentional “overcorrection” technique was adopted by our institution in 2012. This study compares the complications, revisions, and long-term aesthetic outcomes between the “traditional” FOA (T-FOA) and “overcorrection” FOA (O-FOA) approaches for isolated metopic craniosynostosis.
METHODS: A retrospective review was performed of all children who underwent FOA for isolated metopic craniosynostosis from 1987 to 2020 at our institution. Patients with ≥4 years follow-up were included.
RESULTS: Of the 270 patients who underwent surgical correction of isolated metopic synostosis, 165 (61.1%) patients met inclusion criteria (n=100 (60.6%) T-FOA and n=65 (39.4%) O-FOA). Mean age at surgery was 10.9±6.3 months with follow-up of 9.6±4.1 years. There were 15 (9.1%) surgical complications and 49 (29.7%) patients underwent at least one secondary surgery, more commonly in the T-FOA cohort (43.0% vs 9.2%, p<.001). Patients who underwent T-FOA had higher Whitaker scores (2.0±1.0 vs 1.5±0.8, p=.002) and were more likely to have palpable hardware (41.0% vs 24.6%, p=.031), palpable bony irregularities (64.0% vs 21.5%, p<.001), and lateral orbital retrusion (48.0% vs 12.3%, p<.001) compared to those with O-FOA. However, in subgroup analysis of patients ≥10 years old (n=81), aesthetic outcomes (Whitaker 1.7 vs 2.0, p=.341) and reoperation performed/recommended (54.6% vs 72.9%, p=.216) were comparable between the two cohorts.
CONCLUSION: FOA with overcorrection provides a safe and effective way to achieve improved aesthetic outcomes in the intermediate term, but similarly demonstrates a worsening aesthetic outcome over time.
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