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A Comparison of Long-term Aesthetic Outcomes Between Fronto-orbital Distraction Osteogenesis and Conventional Fronto-orbital Advancement and Remodeling
Meagan Wu
*, Benjamin Massenburg, Dillan Villavisanis, Ashley E. Chang, Dominic Romeo, Jinggang Ng, Joseph A. Napoli, Scott Bartlett, Jordan W. Swanson, Jesse A. Taylor
Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
Background: This study compares the long-term photogrammetric and subjective aesthetic outcomes of patients who underwent fronto-orbital distraction osteogenesis (FODO) and traditional fronto-orbital advancement and remodeling (FOAR) for unicoronal synostosis (UCS).
Methods: We retrospectively reviewed
patients treated for nonsyndromic UCS from 2009 to 2023. Aesthetic outcomes at greater than five years postoperatively were compared between patients who underwent FODO and a contemporaneous cohort of age- and sex-matched controls who underwent FOAR. Differences between pre- and postoperative periorbital symmetry ratios, canthal tilt symmetry, orbital dystopia angle (ODA), and frontal bossing angle were calculated. The presence of temporal hollowing, supraorbital retrusion, forehead irregularities, and nasal root deviation were independently assessed by four attending craniofacial surgeons in blinded fashion.
Results: Among 28 patients (14 FODO, 14 FOAR) who underwent surgery at an average age of 7.4±2.1 months, long-term photographs were taken at an average of 6.7±1.8 years postoperatively. All preoperative measurements were similar between cohorts (
p>0.05). The FODO cohort achieved superior margin-to-reflex distance 1 symmetry ratios (
p=0.010), ODA correction (
p=0.027), and canthal tilt symmetry (
p=0.004) compared to the FOAR cohort. Significantly fewer patients in the FODO cohort exhibited temporal hollowing (14% vs. 71%,
p=0.002), and frequency of postoperative strabismus trended towards lower in the FODO cohort (21% vs. 57%,
p=0.053).
Conclusion: Compared to FOAR, FODO was associated with greater improvements in periorbital symmetry, orbital dystopia, and fronto-temporal retrusion at nearly seven years postoperatively. It will be important to follow these patients to cranial maturity to assess the durability of soft tissue changes and adequately compare results.
Aesthetic outcomes in patients with unicoronal synostosis who underwent FOAR versus FODO (n=28).
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