Craniofacial Symmetry Progression Following Strip Craniectomy Versus Fronto-Orbital Advancement in Unilateral Coronal Synostosis

ObjectiveStrip craniectomy (SC) and fronto-orbital advancement (FOA) are 2 techniques for the management of unilateral coronal synostosis (UCS) that differ in timing and approach. However, the tempo and extent of postoperative changes in craniofacial features are less well understood. The purpose of this study is to evaluate the progression of craniofacial symmetry over time following SC or FOA in UCS.DesignA retrospective review of 3-dimensional images obtained preoperatively and at 1- and 2-year postoperatively.SettingTertiary pediatric institution.Patients, ParticipantsThirty-six patients with UCS and 36 control patients.InterventionsStrip craniectomy with helmet or FOA.Main Outcome Measure(s)Three-dimensional craniometric asymmetry measurements.ResultsThe SC group had significantly shorter operative time, less blood loss, and a shorter hospital length of stay. All craniofacial symmetry measurements significantly improved postoperatively in both groups (P < .05), except for orbital width asymmetry in the FOA group at both 1 year and 2 years postoperatively (93.63 ± 3.53%; 93.60 ± 7.41%). There was no significant difference in craniofacial asymmetry measurements between groups. The orbital width (95.15 ± 3.95%) and midface (96.12 ± 3.15%) asymmetry in the SC group remained significantly different from controls at 2 years postoperatively (P < .001; P < .001). The cranial asymmetry (96.43 ± 2.63%), orbital width asymmetry (93.60 ± 7.41%), and midface asymmetry (96.53 ± 1.61%) in the FOA group remained significantly different from controls at 2 years postoperatively (P = .009; P = .042; P = .015).ConclusionsStrip craniectomy and FOA both improved craniofacial symmetry over time, though orbital width and midface differences persisted compared to controls at 2 years postoperatively. Fronto-orbital advancement also showed a persistent cranial asymmetry compared with controls.