Clinical Nasal Deviation Following Midface Advancement in Patients With Syndromic Craniosynostosis

Nasal deviations have been observed in patients following midface surgery. Therefore, the purpose of this study was to evaluate the development of clinically visible nasal deviations following midface surgery and to assess the natural course of the nose over time.

This retrospective study included all Apert and Crouzon patients who underwent midface surgery (Le Fort III (LF3), monobloc (MB), or facial bipartition (FB)). Clinical nasal deviation was assessed on preoperative, short-term postoperative (≤ 1 year), and long-term postoperative (> 1 year) 2D facial photographs by consensus of pediatric ENT surgeons and one craniofacial surgeon. Additionally, pre- and postoperative CT scans were reviewed when available.

Sixty-eight procedures were included (27 Apert, 41 Crouzon); 34 LF3, 31 MB, and 3 FB. The median age at surgery was 10.2 years. Twenty-five (37%) patients were found to have clinically worsening nasal asymmetry, of whom 4 (16%) had pre-existing deviation preoperatively. Seventeen patients with worsening deviation had long-term postoperative facial photographs available (median time 5.8 years), and in 9 (53%), the postoperative clinical nasal deviation appeared to improve spontaneously. We were unable to identify predictive factors for postoperative nasal deviation.

In 16% of the patients, a clinically deviated nose was observed preoperatively. Nasal deviation worsened in 37% of the patients after midface surgery, but also spontaneously improved in 53% of these patients over the long-term. Since predicting the occurrence of nasal deviation and self-correction is difficult, the possibility of developing nasal deviation should be discussed with the patient and their parents.