S6A-03 SESSION 6A: CORONAL SYNOSTOSIS BIFRONTOORBITAL REMODELING REVISITEDc LONG TERM FOLLOW-UP OF OPERATED PATIENTS FOR SYNOSTOTIC PLAGIOCEPHALY

Introduction: Synostotic plagiocephaly represents a surgical puzzle, for which multiple surgical methods have been developed. The objectives were: 1.Demonstrate the facial features presented by pts over a long period of time, the persistent abnormalities showed and its treatment. 2. analyze pts operated by the same surgeons at a single center. Methods: A retrospective chart review. Inclusion criteria for patients were as follows: (1) unicoronal synostosis treated with BFOA, (2) previously unoperated skull, (3) follow-up period of at least 10 years, (4) informed consent, (5) treated at a single medical institution. The demographic info, clinical-morphologic data, postoperative-surgical complications and reoperation rate were analyzed according to age at surgery (BFOA), based on three groups: 0–6, 6–12, >12 months. Complications were analyzed in consonance with the surgical aspects (i.e. dural tears, etc.), the Whitaker, Sloan and Clavien-Dindo classifications. Reoperation was reported based on functional or morphological aspects. Results: 27 pts included; 21 female, 6 male; 3 had a family member affected. Age at operation was 6—28 mo(average 10). The advancement distance was 10—25 mm (average 18.7). Groups according to age at surgery were: 0–6 (n=7), 6–12 (n=11), >12 mo (n=9). The complication rate or reoperation rate was not associated with the distance advanced. 4 pts had dural tears but none had a persistent CSF leak; 1 patient had a hematoma (not related to surgery) and 1 patient had a conspicuous scar. According to the Whitaker classification, 12 pts were class II (7 were reoperated); and three patients were class III, requiring additional procedures. All pts were considered to have an adequate morphological result on the surgical table; deficient morphology was encountered: between 2–5 yrs of age in 11 pts (40.7%), 1 required reoperation (lesser bone contouring revisions); between 5–10 yrs of age in 8 pts, 5 required reoperation; and 10–15 years of age in 2 patients, the two required reoperation. Conclusion: Several factors affect patients with synostotic plagiocephaly, some can be modified in surgery and others will prevail as the individual grows. Immediate postoperative results might be satisfactory for variables that can be altered surgically, following a detailed and meticulous surgical technique. Yet, the craniofacial region will show progressive changes related to the condition, that may affect the outcome in a period that may last up to 15 years from the initial surgery. The use of adjuvant procedures (i.e. fat grafting, bone grafts and implants) are helpful tools to achieve an adequate final result.