Derek M Steinbacher1, Jason Wink, Scott P Bartlett. 1. New Haven, Conn.; and Philadelphia, Pa. From Plastic Surgery, Yale University; University of Pennsylvania School of Medicine; and Children's Hospital of Philadelphia, University of Pennsylvania.
Abstract
BACKGROUND: Temporal hollowing occurs frequently following surgical correction of unicoronal synostosis. This is characterized by a depression in the posterolateral orbitotemporal region. Both soft-tissue and bony causes have been postulated to underpin this problem. The authors investigated the soft-tissue and bony morphology of the temporal region in surgically treated unicoronal synostosis patients. METHODS: A retrospective analysis of adolescent patients with temporal hollowing who underwent unicoronal synostosis repair as infants was carried out. Demographic data and computed tomographic craniometric parameters were obtained and analyzed using the t test. Photographs were graded subjectively and compared with quantitative data. RESULTS: Fifteen children (seven boys and eight girls; mean age, 13 years) were identified. Seventeen patients (10 boys and seven girls; mean age, 14 years) were used as controls. The affected side showed temporal constriction, compared with controls, along the supraorbit and anterior temple. The sella-to-pterion distance was also less, but not statistically so. Soft-tissue analysis revealed decreased thickness of the affected temporalis muscle compared with unaffected and control sides (range, 1 to 3 mm less). The affected fat pad width was not statistically different from unaffected and controls. Subjective clinical grading did not demonstrate statistical correlations with quantitative data. CONCLUSIONS: Temporal hollowing occurs following surgical correction of unicoronal synostosis, despite original overcorrection, because of bony constriction along the anterior bandeau. Decreased thickness of the temporalis muscle may also contribute to this depression, whereas the superficial fat pad does not play a role. Subjective clinical scoring does not strictly correlate with severity of craniometric measurements. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.(Figure is included in full-text article.).
BACKGROUND: Temporal hollowing occurs frequently following surgical correction of unicoronalsynostosis. This is characterized by a depression in the posterolateral orbitotemporal region. Both soft-tissue and bony causes have been postulated to underpin this problem. The authors investigated the soft-tissue and bony morphology of the temporal region in surgically treated unicoronalsynostosispatients. METHODS: A retrospective analysis of adolescent patients with temporal hollowing who underwent unicoronalsynostosis repair as infants was carried out. Demographic data and computed tomographic craniometric parameters were obtained and analyzed using the t test. Photographs were graded subjectively and compared with quantitative data. RESULTS: Fifteen children (seven boys and eight girls; mean age, 13 years) were identified. Seventeen patients (10 boys and seven girls; mean age, 14 years) were used as controls. The affected side showed temporal constriction, compared with controls, along the supraorbit and anterior temple. The sella-to-pterion distance was also less, but not statistically so. Soft-tissue analysis revealed decreased thickness of the affected temporalis muscle compared with unaffected and control sides (range, 1 to 3 mm less). The affected fat pad width was not statistically different from unaffected and controls. Subjective clinical grading did not demonstrate statistical correlations with quantitative data. CONCLUSIONS: Temporal hollowing occurs following surgical correction of unicoronalsynostosis, despite original overcorrection, because of bony constriction along the anterior bandeau. Decreased thickness of the temporalis muscle may also contribute to this depression, whereas the superficial fat pad does not play a role. Subjective clinical scoring does not strictly correlate with severity of craniometric measurements. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.(Figure is included in full-text article.).
Authors: Benjamin Masserano; Albert S Woo; Gary B Skolnick; Sybill D Naidoo; Mark R Proctor; Matthew D Smyth; Kamlesh B Patel Journal: Cleft Palate Craniofac J Date: 2017-12-14