Despite Surgery To Correct Congenital Deformity, Facial Asymmetry Persists

Main Category: Cosmetic Medicine / Plastic Surgery
Also Included In: Pediatrics / Children's Health;  Genetics
Article Date: 27 Feb 2008 - 3:00 PDT

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Adults and teens that underwent surgery as infants to correct a congenital condition that causes the forehead and face to appear uneven still have a degree of facial asymmetry years later, according to new research led by a Hasbro Children's Hospital surgeon.

The study, published in the February issue of Plastic and Reconstructive Surgery, focused on unilateral coronal synostosis, a type of craniosynostosis, in which the bones of the skull on one side of the head fuse prematurely. Craniosynostosis, or early fusion of the cranial sutures, affects 1 in 2000 live births. During corrective surgery, known as fronto-orbital advancement, surgeons remove and reshape the bones of the forehead and upper eye sockets, replacing them in a more normal anatomic position. This is typically performed during infancy.

"Although there appears to be some lingering asymmetry years after many of these patients underwent corrective surgery, most patients and their families don't notice these differences, which do not appear to pose any significant health risks," said lead author Albert Oh, M.D., director of the craniofacial surgery program at Hasbro Children's Hospital. "Nevertheless, it's important that we understand more about this asymmetry, which could lead to improvements of the operation and further our knowledge regarding the cause of craniosynostosis."

Oh, who's also an assistant professor in the department of surgery at The Warren Alpert Medical School of Brown University, led this research while at Children's Hospital Boston and Harvard Medical School.

In the study, Oh and colleagues used three-dimensional photo technology known as photogrammetry to digitally measure the faces of adult and adolescent patients with unilateral coronal synostosis who had undergone corrective surgery during infancy. They focused on different measurements comparing one side of the face to the other.

The researchers observed that average measurements on the side of the face affected by unilateral coronal synostosis were invariably shorter in comparison to the opposite side. They also found consistent rotation of the nose and facial midline away from the side of the fusion. Interestingly, the severity of long-term postoperative facial symmetry did not depend on either age at surgery or age at follow-up.

"While this study conclusively documented persistent postoperative facial asymmetry, our study group of 15 patients was relatively small. What is really needed is a long-term prospective study comparing preoperative and postoperative facial measurements," said Oh.

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Study co-authors were John B. Mulliken, M.D.; Julielynn Wong, M.D.; Eiichi Ohta, M.D.; Gary F. Rogers M.D.; and Curtis K. Deutsch, M.D., all associated with Children's Hospital Boston. The photogrammetric device used in the study - the 3dMDface system - was funded in part by a grant from the National Center for Research Resources, National Institutes of Health, to the Children's Hospital Boston General Clinical Research Center.

Hasbro Children's Hospital (http://www.hasbrochildrenshospital.org/) in Providence, RI, is the pediatric division of Rhode Island Hospital, the largest teaching hospital of The Warren Alpert Medical School of Brown University. A private, not-for-profit hospital, it is nationally recognized for its child protection program and Draw-A-Breath asthma and allergy initiative. It is also the home of the Injury Prevention Center, which aims to reduce accidental injuries in children, as well as the region's only pediatric imaging center. The hospital has pioneered numerous procedures and is at the forefront of fetal surgery, orthopedics and pediatric neurosurgery. Hasbro Children's Hospital is a member of the Lifespan health system.

Source: Jessica Collins Grimes
Lifespan

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