Spontaneous Correction of Facial Torsion in Nonsyndromic Unicoronal Craniosynostosis: Does Time Heal All?

Area of Science:

• Craniofacial Surgery
• Pediatric Plastic Surgery
• Medical Imaging Analysis

Background:

• Unicoronal synostosis leads to midface asymmetry, specifically contralateral facial torsion.
• The spontaneous correction of this facial torsion after frontal orbital advancement surgery is not well-established.

Purpose of the Study:

• To evaluate the degree of spontaneous clinical correction of facial torsion following bifrontal orbital advancement surgery.
• To assess both quantitative and qualitative changes in facial torsion post-surgery.

Main Methods:

• Retrospective review of 62 nonsyndromic unicoronal synostosis patients undergoing frontal orbital advancement (1994-2016).
• Preoperative and postoperative clinical photographs were analyzed for facial torsion using nasal tip angulation from the mid-sagittal plane.
• Measurements were quantified, and torsion was qualitatively assessed as perceptible or not perceptible.

Main Results:

• A mean quantitative correction of facial torsion of 1.6 degrees was observed.
• Despite statistical correction, all patients exhibited persistent perceptible facial torsion postoperatively.
• Qualitative assessment indicated no significant change in the subjective degree of facial torsion from pre- to long-term postoperative follow-up.

Conclusions:

• Bifrontal orbital advancement provides a statistically significant, albeit small, correction of facial torsion in unicoronal synostosis.
• The surgical correction does not eliminate perceptible facial asymmetry, which remains evident in the long term.
• Further investigation may be needed to address residual perceptible facial torsion and improve aesthetic outcomes.