Nonsyndromic unilateral coronal synostosis: A comparison of fronto-orbital advancement and endoscopic suturectomy

Background: Comparative effectiveness research is needed to optimize treatment of unilateral coronal synostosis (UCS). This study compares perioperative morbidity, ophthalmic, and aesthetic outcomes of patients with nonsyndromic UCS treated by endoscopic suturectomy (ES) or front-orbital advancement (FOA). Methods: From 2004-2015, patients with UCS were reviewed and data recorded for: operative details, re-operations, aesthetic result using Whitaker classification, severity of strabismus and need for surgical correction. Categorical data were analyzed by Fisher exact test and continuous data analyzed by Wilcoxon rank-sum test. Results: Ninety-four patients were treated with ES (n= 60) or FOA (n=34). Median age of follow-up was 3.5yrs (1-9) for ES and 5.0yrs (2-11) for FOA (p=0.06). The ES group had a lower operative time (42 vs. 216 mins), length of stay (1 vs. 4 days), blood loss (25 vs. 260cc), and transfusion rate (0% vs. 88%). Two patients treated with FOA required secondary intervention for intracranial pressure. Thirty-one percent (16/52) of the ES group and 65% (19/29) of the FOA group developed clinically significant strabismus requiring surgical repair (p=0.002). In the ES group, 88% (50/57) were Whitaker class I and 5% class II. In the FOA group, 41% (14/34) were class I and 44% class II. Need for bony revision (2/57 vs. 3/34) and secondary cranial procedure (2/57 vs. 2/34) was similar following ES and FOA. Conclusion: For treatment of UCS, ES is associated with lower morbidity and comparable aesthetics. Patients treated with ES are half as likely to require strabismus surgery compared to those treated with FOA. * Joint senior authorship Presented at: International Society of Craniofacial Surgery meeting, Cancun, Mexico, 2017. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding Author: Kathryn V. Isaac, MD, 300 Longwood Avenue, Boston, Massachusetts, USA. kisaac@hsph.harvard.edu ©2018American Society of Plastic Surgeons

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