Impact of Fronto-Orbital Advancement on Frontal Sinus Volume, Morphology, and Disease in Nonsyndromic Craniosynostosis.

Background: Fronto-orbital advancement (FOA) for nonsyndromic craniosynostosis (NSC) has been thought to injure frontal sinus buds, lead to chronic sinus disease, and influence final forehead shape. This study investigates the effect of FOA in infancy on subsequent frontal sinus volume, morphology, and disease. Methods: We conducted a retrospective review of NSC patients treated with FOA in infancy with a head CT performed at age 7-18 years. Facial trauma patients served as age-matched controls. Frontal sinus characteristics were determined using 3D reconstructions. Results: The study included 33 NSC patients who underwent FOA (n=20 unicoronal synostosis (UCS), n=13 metopic synostosis) and 20 control patients. The incidence of at least unilateral pneumatization was 94% for FOA subjects and 95% for control subjects. Mean frontal sinus volumes for UCS, metopic, and control groups were 3427+/-2294mm3, 4576+/-3510mm3, and 4157+/-3963mm3, respectively (p=0.598). Asymmetry scores were as follows: UCS 56+/-35%, metopic 36+/-33%, control 23+/-24% (p=0.010). There was prominent frontal sinus asymmetry within the UCS group, with the unaffected side demonstrating increased pneumatization. Frontal sinus volume correlated with age of CT but not with age of FOA. Inter-rater reliability was 0.997. One FOA and zero control subjects demonstrated CT evidence of frontal sinus disease. Conclusions: Frontal sinus volume, morphology, and disease do not significantly differ between control subjects and NSC subjects following FOA, but subtle differences such as increased asymmetry in the UCS group can be appreciated. Further research with syndromic craniosynostosis patients undergoing multiple procedures may help elucidate the association between surgical disruption and frontal sinus development. (C)2016American Society of Plastic Surgeons

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