Craniofacial Symmetry Progression following Strip Craniectomy in Unilateral Coronal Craniosynostosis

BACKGROUND: Strip craniectomy in unilateral coronal craniosynostosis (UCS) is associated with shorter operations, fewer complications, reduced transfusions, fewer ophthalmic disorders, and improved craniofacial morphology. However, the tempo and extent of changes in craniofacial features after surgery are less well understood. The purpose of this study is to evaluate the progression of craniofacial symmetry over time after strip craniectomy in UCS. METHODS: Eighteen patients with UCS were evaluated before surgery and at 3 months, 6 months, 1 year, and 2 years after strip craniectomy with helmet therapy. Three-dimensional images were used to assess craniofacial asymmetries. Craniofacial composites were created. Eighteen control patients were included for comparison. RESULTS: Before surgery, brow projection asymmetry (92.51% ± 4.23%; P < 0.001), orbital width (89.26% ± 6.57%; P = 0.003) and height asymmetry (118.42% ± 7.79%; P = 0.043), and midface asymmetry (91.42% ± 3.14%; P < 0.001) were significantly different between sides. Cranial asymmetry (91.97% ± 4.36%), decreased height of the ipsilateral orbit (6.50 ± 1.09 degrees), contralateral forehead bossing (10.51 ± 1.64 degrees), and nasal and chin deviation to the contralateral side (7.90 ± 2.30 degrees and 5.86 ± 1.48 degrees, respectively) were present. By 3 months after surgery, all craniofacial measurements had significantly improved from their preoperative values ( P < 0.050). Cranial asymmetry (98.73% ± 2.02%), frontal bossing (1.28 ± 0.27 degrees), brow projection asymmetry (98.34% ± 1.27%), orbital height (102.47% ± 8.40%) and vertical asymmetry (0.84 ± 0.46 degrees), and nasal and chin deviation (1.60 ± 0.89 degrees and 1.17 ± 0.59 degrees, respectively) were not significantly different from controls at 2 years. Orbital width and midface asymmetry remained significantly different from controls. CONCLUSIONS: Patients with UCS demonstrated significant asymmetry before surgery that significantly improved by 3 months after surgery. Most craniofacial features normalized compared with controls by 2 years after surgery, except for orbital width and midface asymmetry.