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

Unicoronal synostosis creates facial asymmetry typified by torsion of the midface to the contralateral side. Whether the facial tort corrects spontaneously after frontal orbital advancement surgery remains debatable. The authors aimed to evaluate the degree of clinically evident spontaneous correction of facial torsion after bifrontal orbital advancement. The authors performed a retrospective review of nonsyndromic unicoronal craniosynostosis patients treated with frontal orbital advancement between 1994 and 2016 by evaluating preoperative and postoperative clinical photographs. Preoperative and postoperative facial torsion was serially measured on AP photographs by angulation of the nasal tip from the mid-sagittal plane. Facial torsion was classified as perceptible or not perceptible for qualitative review and angle measurements were recorded for quantification. Sixty-two patients were included. The mean age at surgery was 11 months with the mean follow-up of 57 months. Two hundred sixty-three photographs were reviewed. Mean nasal tip angulation was 6.2±2.1 degrees at the first review with a correction of 1.6±1.82 degrees observed at the final review. All patients had persistent perceptible facial torsion. A statistically significant correction of facial torsion by 1.6 degrees was present but did not lead to a perceptible improvement in facial torsion. The qualitative evaluation demonstrated that perceptible facial torsion was present in both short-term and long-term postoperative photographs in all cases. Although the severity of perceptible asymmetry was not quantified, a subjective degree of perceptible facial torsion preoperatively was unchanged in long-term follow-up despite statistically significant quantitative correction.