Positive Impact of Frontofacial Advancement on Intracranial Volumes in Patients With Syndromic Craniofaciosynostosis

Background: Le Fort (LF) III midface distraction osteogenesis is one of the main techniques for correcting midface deficiency encountered in craniofaciosynostosis. However, regardless of the technique used, there may be a deterioration in the result, with a recurrence of facial hypoplasia, requiring a new procedure to advance the midface. Methods: In this retrospective study, computed tomography scans before and after LF III distraction osteogenesis of 7 patients (3 boys and 2 girls with Crouzon syndrome, 1 boy with Apert syndrome, and 1 boy with Pfeiffer syndrome) were analyzed in vestibular orientation. The ages ranged from 4 to 11 years old. All patients presented with syndromic craniofaciosynostosis with class III malocclusion and proptosis. The 3 cranial fossae were segmented slice by slice, and their volumes were calculated. The total intracranial volume was calculated by summing the volumes of the 3 cranial fossae. The Wilcoxon signed-rank test was used to compare the measured values before and after LF III distraction. A P value of less than 0.05 was considered statistically significant. Results: Total intracranial volume significantly increased (6%; P = 0.016) in the total study group. Volumes of the anterior and middle cranial fossae increased insignificantly (22.6%, P = 0.33; 4.8%, P = 0.29). The volume of the posterior cranial fossae insignificantly decreased (0.3%, P = 0.58). Conclusions: A significant increase in total intracranial volume after LF III advancement in syndromic craniofaciosynostosis patients was reported.