[Outcome of nasal deviation in plgiocaphaly after bilateral frontocranial modeling in childhood]

The deviation of the nasal root is one of the major deformities in unilateral coronal synostosis. The objectives of this study are to evaluate the results of bilateral frontocranial remodeling on nasal deviation, focusing on the patient's age at the time of the operation. All the patients undergoing bilateral frontocranial remodeling for plagiocephaly and followed for a minimum of 5 years postoperatively, without any other craniofacial surgery were included in the study. Based on photographic data, 42 patients were assigned to one of 4 morphologic categories: M1 = absence of nasal deviation; M2 = minor nasal deviation with no or minor revision required; M3 = severe nasal deviation with major alternative osteotomies required or performed; M4 = major nasal deviation with major craniofacial procedure and bone-grafting required or performed. Thirty-nine patients presented with significant nasal deviation before surgery. Ninety-two percent had a morphologic improvement and 62% had no residual nasal deviation (M1) more than 5 years after the procedure. The best results were obtained in patients operated between the ages of 12 and 24 months. All patients who underwent surgery during this period obtained improvement of the deformity, and 90% had no residual deviation. In contrast, when patients were operated before the age of 12 months, 91% obtained improvement of the nasal deformity, and 57% were assigned to the M1 category. Additionally, surgery performed between the ages of 2 and 4 resulted in 67% of partial correction and 33% of ideal correction. The most difficult age group to correct were children 4 years and older. Of the 4 patients in this group, one required major secondary reconstruction (M3), and only one patient achieved complete correction. Although the endpoint for correction is an aesthetic assessment, cephalometric analysis was also performed in 29 cases. Comparison of the evaluations gave equivalent results.