Temporal hollowing following surgical correction of unicoronal synostosis
Derek M Steinbacher1, Jason Wink, Scott P Bartlett
1New 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.
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.).
Related Concept Videos
01:22Sutures of the Skull
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
01:14Cranial Bones: Superior and Posterior View
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...
01:27Cranial Bones: Lateral View
The temporal bone forms the lower lateral side of the skull. The temporal bone is subdivided into several regions. The flattened upper portion is the squamous portion of the temporal bone. Below this area and projecting anteriorly is the zygomatic process of the temporal bone, which forms the posterior portion of the zygomatic arch. Posteriorly is the mastoid portion of the temporal bone. Projecting...