Comparison of the soft tissue thickness of the midface in craniosynostosis

Craniosynostosis is classified according to the included sutures as either symmetric, such as scaphocephaly and brachycephaly, or asymmetric, such as plagiocephaly. Asymmetric craniosynostosis has been known to exert asymmetric effects not only on the cranium but also on the facial skeleton. Nonetheless, the presence of asymmetry in soft tissues is only speculative and is based on the experience of plastic surgeons. In our study, after measuring the surface coordinates of soft and bone tissues from numerous positions on three-dimensional computed tomography (CT), the distance between the coordinates was calculated and the thickness of the soft tissues was obtained by objective measurements. The subjects included a control group of 8 symmetric craniosynostosis patients, and the study group consisted of 7 asymmetric craniosynostosis patients selected by computed tomographic data. In each patient, the thickness of the midfacial area was measured by dividing it into frontal and lateral views. The results show that in symmetric craniosynostosis, the thicknesses of the right and the left soft tissues were statistically identical. However, in asymmetric craniosynostosis, the thickness of soft tissues in the hypoplastic side was statistically significantly thin according to measurements taken at both the frontal and the lateral views (P = 0.048 and P = 0.034, respectively). This suggests that surgeons should pay attention to the asymmetry of soft tissues during follow-up and when correcting facial asymmetry in asymmetric craniosynostosis.