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Asymmetrical cranio-orbital facial stenosis
W Mühlbauer1, H Anderl, A Schmidt
1Department of Plastic, Reconstructive, and Hand Surgery, Klinikum Bogenhausen, München, Germany.
Insights
Cranio-orbital facial scoliosis, a condition of premature skull fusion, requires surgical intervention for optimal outcomes. Early infant surgery promotes natural facial reshaping, while older patients need complex osteotomies for correction.
Area of Science:
- Craniofacial surgery
- Pediatric plastic surgery
- Orthognathic surgery
Background:
- Cranio-orbital facial scoliosis results from unilateral premature stenosis of the craniofacial skeleton.
- Plagiocephaly is a subtype of this complex craniofacial deformity.
- The condition necessitates operative treatment to prevent progressive deformity.
Observation:
- Functional, aesthetic, and psychosocial factors indicate the need for surgical correction.
- Early intervention in infancy (3-6 months) is advocated.
- Treatment for adolescents and adults involves multisegmental osteotomies and definitive remodeling.
Findings:
- Early surgery involves wide resection of stenosed cranial and orbital sutures.
- Repositioning and remodeling in infants leverage natural autodynamic reshaping of nasoethmoidal and midface structures.
- Adolescent and adult treatment requires precise osteotomies for long-term correction.
Implications:
- Timely surgical management can significantly improve functional, aesthetic, and psychosocial aspects for patients with cranio-orbital facial scoliosis.
- Infant surgery capitalizes on growth potential for improved midface development.
- Definitive surgical correction in older patients addresses complex skeletal malformations.
Abstract:
Cranio-orbital facial scoliosis is the result of unilateral premature stenosis of the craniofacial skeleton. Plagiocephaly is only a subform of the syndrome. The deformity progresses unless operative treatment is given. Operative treatment is indicated for functional, aesthetic, and psychosocial reasons. We advocate early operation in infancy (3 to 6 months) consisting of wide resection of the stenosed sutures of the cranium and orbit, repositioning, and remodeling relying on the spontaneous autodynamic reshaping of the nasoethmoidal complex and the midface structures during the course of further growth. In adolescents and adults, multisegmental osteotomies and remodeling into a definitive position are necessary.