Skeletal and Soft Tissue Surgeries in the Long-term Management of Patients With Syndromic Craniosynostosis: A 20-Year Review.

IF 1.4 4区医学 Q3 SURGERY

Annals of Plastic Surgery Pub Date : 2024-10-01 DOI:10.1097/SAP.0000000000004101

Tayla Moshal, Idean Roohani, Marah Jolibois, Sasha Lasky, Eloise W Stanton, Medha Vallurupalli, Erin M Wolfe, Naikhoba C O Munabi, Jeffrey A Hammoudeh, Mark M Urata

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引用次数: 0

Abstract

Background: Soft tissue procedures are often crucial for normalizing the long-term facial appearance in patients with syndromic craniosynostosis, yet they are underrepresented in the literature and existing treatment algorithms. This study evaluated secondary soft tissue surgeries in relation to skeletal operations in patients with syndromic craniosynostosis.

Methods: A retrospective review evaluated patients with syndromic craniosynostosis treated at a tertiary children's hospital from 2003 to 2023. Craniofacial skeletal and soft tissue procedures were assessed for timing and frequency. Skeletal surgeries included redo fronto-orbital advancements, monobloc advancement/distraction ± facial bipartition, and LeFort III or III/I advancement/distraction. Soft tissue surgeries encompassed oculoplastic procedures, scalp reconstruction, fat grafting, and septorhinoplasty.

Results: Of 106 patients with syndromic craniosynostosis, 57 (57.8%) underwent ≥1 secondary skeletal operation, and 101 (95.3%) underwent ≥1 soft tissue procedures, averaging 3.7 ± 3.3 soft tissue procedures per patient. Patients who underwent secondary forehead advancement had significantly higher rates of subsequent lateral canthopexy (71.4% vs 25.6, P < 0.001), ptosis reconstruction (17.9% vs 7.7%, P = 0.025), and frontotemporal fat grafting (50.0% vs 15.4%, P < 0.001) than those who did not. Patients who underwent midface advancement surgery had significantly higher rates of subsequent lateral canthopexy (65.4% vs 11.1%, P < 0.001), medial canthopexy (7.7% vs 0.0%, P = 0.038), scalp reconstruction (36.5% vs 16.7%, P = 0.020), frontotemporal fat grafting (34.6% vs 14.8%, P = 0.018), malar fat grafting (11.5% vs 0.0%, P = 0.010), and septorhinoplasty (26.9% vs 1.9%, P < 0.001) than those who did not. Specifically, LeFort III or III/I advancement/distractions were significantly associated with higher rates of subsequent septorhinoplasties (33.3% vs 1.6%, P < 0.001). The mean follow-up was 10.2 ± 7.0 years.

Conclusions: This study revealed an intricate interplay between skeletal and soft tissue surgery in patients with syndromic craniosynostosis. Exploring techniques to reduce the need for further corrective surgery and anticipating necessary secondary interventions may improve patient counseling and outcomes.

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综合颅畸形患者长期治疗中的骨骼和软组织手术：20年回顾

背景：软组织手术对于综合颅畸形患者的长期面部外观正常化往往至关重要，但在文献和现有治疗算法中却代表性不足。本研究评估了综合颅畸形患者二次软组织手术与骨骼手术的关系：一项回顾性研究评估了 2003 年至 2023 年在一家三级儿童医院接受治疗的综合颅畸形患者。对颅面骨骼和软组织手术的时间和频率进行了评估。骨骼手术包括重做前眶前移、单体前移/牵引（±面部双分区）和 LeFort III 或 III/I 前移/牵引。软组织手术包括眼部整形、头皮重建、脂肪移植和鼻中隔成形术：结果：在106名综合征颅骨发育不良患者中，57人（57.8%）接受了≥1次二次骨骼手术，101人（95.3%）接受了≥1次软组织手术，平均每位患者接受了3.7 ± 3.3次软组织手术。接受过二次额头前移术的患者随后接受外侧眦角整形术（71.4% vs 25.6，P < 0.001）、上睑下垂重建术（17.9% vs 7.7%，P = 0.025）和额颞部脂肪移植术（50.0% vs 15.4%，P < 0.001）的比例明显高于未接受此类手术的患者。接受中面部前移手术的患者随后进行外侧开颅（65.4% vs 11.1%，P < 0.001）、内侧开颅（7.7% vs 0.0%，P = 0.038）、头皮重建（36.5% vs 16.7%，P = 0.020）、额颞部脂肪移植（34.6% vs 14.8%，P = 0.018）、颞部脂肪移植（11.5% vs 0.0%，P = 0.010）和鼻中隔成形术（26.9% vs 1.9%，P < 0.001）。具体而言，LeFort III 或 III/I 推进/牵拉与随后进行鼻中隔成形术的较高比例显著相关（33.3% vs 1.6%，P < 0.001）。平均随访时间为 10.2 ± 7.0 年：这项研究揭示了综合颅畸形患者骨骼和软组织手术之间错综复杂的相互作用。探索减少进一步矫正手术需求的技术和预测必要的二次干预可能会改善患者咨询和治疗效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Plastic Surgery 医学-外科

CiteScore

2.70

自引率

13.30%

发文量

584

审稿时长

6 months

期刊介绍： The only independent journal devoted to general plastic and reconstructive surgery, Annals of Plastic Surgery serves as a forum for current scientific and clinical advances in the field and a sounding board for ideas and perspectives on its future. The journal publishes peer-reviewed original articles, brief communications, case reports, and notes in all areas of interest to the practicing plastic surgeon. There are also historical and current reviews, descriptions of surgical technique, and lively editorials and letters to the editor.