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. 2021 Jan-Feb;32(1):87-91.
doi: 10.1097/SCS.0000000000006997.

Midface Morphology and Growth in Syndromic Craniosynostosis Patients Following Frontofacial Monobloc Distraction

Cristiano Tonello  1 , Lucia H S Cevidanes  2 , Antonio C O Ruellas  2   3 , Nivaldo Alonso  4
Affiliations

Midface Morphology and Growth in Syndromic Craniosynostosis Patients Following Frontofacial Monobloc Distraction

Cristiano Tonello et al. J Craniofac Surg. 2021 Jan-Feb.

Abstract

Background: Facial advancement represents the essence of the surgical treatment of syndromic craniosynostosis. Frontofacial monobloc distraction is an effective surgical approach to correct midface retrusion although someone consider it very hazardous procedure. The authors evaluated a group of patients who underwent frontofacial monobloc distraction with the aim to identify the advancement results performed in immature skeletal regarding the midface morphologic characteristics and its effects on growth.

Methods: Sixteen patients who underwent frontofacial monobloc distraction with pre- and postsurgical computed tomography (CT) scans were evaluated and compared to a control group of 9 nonsyndromic children with CT scans at 1-year intervals during craniofacial growth. Three-dimensional measurements and superimposition of the CT scans were used to evaluate midface morphologic features and longitudinal changes during the craniofacial growth and following the advancement. Presurgical growth was evaluated in 4 patients and postsurgical growth was evaluated in 9 patients.

Results: Syndromic maxillary width and length were reduced and the most obtuse facial angles showed a lack in forward projection of the central portion in these patients. Three-dimensional distances and images superimposition demonstrated the age did not influence the course of abnormal midface growth.

Conclusion: The syndromic midface is hypoplastic and the sagittal deficiency is associated to axial facial concavity. The advancement performed in mixed dentition stages allowed the normalization of facial position comparable to nonsyndromic group. However, the procedure was not able to change the abnormal midface architecture and craniofacial growth.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Reference points on the surface of the 3-dimensional model. (A) Points on the anterior surface of the face. (B) Maxillary points in lower view. (C) Skull base point in the sagittal view 3-dimensional model sectioned.
FIGURE 2.
FIGURE 2.
Representation of facial angles FrontozygR-Nasion-FrontozygL (blue line), OrbR-pointA-OrbL (red line), and ZygR-pointA-ZygL (yellow line). (A) Control (T0). (B) SC (T1) and SC (T2). (C) Control (T0). (D) SC (T1) and SC(T2).
FIGURE 3.
FIGURE 3.
Angle representation formed among the Sella-pointA-Nasion points (SNA). (A) Control (T0) (blue line). (B) SC (T1) (red line) and SC (T2) (white line) in image superimpositon.
FIGURE 4.
FIGURE 4.
Colormaps of 3-dimensional surface models of T1 and T2 superimposition. The color scale shows the average advancement of the SC group in millimeters. Red represents the anterior displacement and green any changes. (A) Result of frontofacial monobloc distraction bone structure. (B) Right soft tissues.
FIGURE 5.
FIGURE 5.
Colormaps represent the growth of midface in the studied groups. (A) Control (T–T1). (B) SC (T1–T2). (C) SC (T2–T3).
See this image and copyright information in PMC

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