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Coronal ring involvement in patients treated for unilateral coronal craniosynostosis
Jason A Dundulis1, Devra B Becker, Daniel P Govier
1Washington University School of Medicine, St. Louis Children's Hospital, and Cleft Lip/Palate and Craniofacial Deformities Center, Mo. 63110, USA.
Plastic and Reconstructive Surgery
|December 4, 2004
Summary
Unilateral coronal synostosis involves more than just the frontoparietal suture. Other coronal ring sutures, like the frontosphenoidal, also contribute to orbital and skull base changes in infants.
Area of Science:
- Craniofacial surgery
- Pediatric neurosurgery
- Medical imaging
Background:
- Unilateral coronal synostosis is typically defined by frontoparietal suture fusion.
- However, other sutures in the coronal ring can fuse independently or concurrently, leading to similar clinical presentations.
- Understanding the role of all coronal ring sutures is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To retrospectively analyze high-resolution computed tomographic (CT) data sets of infants with unilateral coronal synostosis.
- To determine the patency of various sutures within the coronal ring, including the frontoparietal, frontosphenoidal (intraorbital and extraorbital), and frontoethmoidal sutures.
- To correlate sutural patency with orbital dimensions and endocranial base deflection.
Main Methods:
- Retrospective analysis of CT scans from 33 infants undergoing surgical correction for unilateral coronal synostosis.
- Assessment of sutural patency using Analyze imaging software.
- Measurement of orbital dimensions and endocranial base deflection angles, with observers blinded to sutural status.
Main Results:
- Frontoethmoidal synostosis was not observed in any patients.
- Two patients presented with isolated frontosphenoidal suture synostosis without frontoparietal involvement.
- Patients with combined frontosphenoidal and frontoparietal synostosis showed significantly less vertical orbit asymmetry compared to those with only frontoparietal synostosis (p < 0.05).
- Endocranial base deflection occurred ipsilateral to the synostosis in both groups, with greater deflection in patients with combined synostoses (p < 0.005).
Conclusions:
- The extent of coronal ring suture synostosis influences the degree of orbital dysmorphology and endocranial base deflection.
- Diagnosis of unilateral coronal synostosis should consider the involvement of sutures beyond the frontoparietal suture.
- Comprehensive evaluation of all coronal ring sutures is essential for understanding the pathogenesis of unilateral coronal synostosis.