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Pterional Z-Plasty with Frontal Orbital Advancement for Unicoronal Synostosis: Long-Term Craniometric Outcomes
Tiffany E. Jeong
*, Justin Beiriger, Alzbeta Novotna, Michael Hernandez, Viraj Govani, Victoria García Rodríguez, Shelby Nathan, Jesse A. Goldstein, Lucas Dvoracek
Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
BackgroundOvercorrection in frontal orbital advancement (FOA) aims to mitigate retrusion of the bandeau in post-operative unicoronal synostosis (UCS) patients. This study describes our institutional technique for bandeau overcorrection and evaluates craniometric outcomes in UCS patients.
Methods We reviewed patients with isolated UCS who received the proposed surgical technique from a single surgeon at a tertiary medical center. Craniometric analyses were performed in 3D Slicer for patients with pre-, immediate post-, and 2 years post-operative CT scans. Absolute differences were used to compare sides of the face (affected - unaffected). Paired t-test with Bonferroni correction were used.
Results 18 patients with UCS received FOA with the proposed technique at 12.63±1.93 months. Complication rates were low, with one patient having delayed wound healing (5.5%). Preoperatively, patients had forehead protrusion asymmetry (−10.22 ± 1.59 mm), orbital width asymmetry (−1.32 ± 2.89 mm), orbital height asymmetry (+0.66 ± 1.94 mm), and brow protrusion asymmetry (−8.59 ± 1.93 mm). In the immediate post-operative CT scans, the orbital widening graft measured 9.9±3.1 mm, and the pterional advancement length 20.8±7.0 mm. For the subset of 10 patients with 2-year post-op CT, forehead projection asymmetry improved by a mean of 4.72 ± 2.46 mm (95% CI: −6.48 to −2.96, p = 0.0001), and brow projection asymmetry improved by 4.31 ± 2.28 mm (95% CI: −5.94 to −2.68, p = 0.0001). Orbital width asymmetry did not significantly change (mean difference −0.24 ± 2.94 mm, 95% CI: −2.34 to 1.87, p = 0.401), while orbital height asymmetry showed a borderline reduction of 1.52 ± 2.63 mm (95% CI: −3.40 to 0.36, p = 0.0503).
Conclusion Our study describes an overcorrection FOA technique with pterional z-plasty and demonstrates sustained craniometric improvement in patients 2 years after surgery. Forehead and brow symmetry improved significantly, with low complication rates.
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