Skip to main content

Advertisement

Log in

3D printing guided surgery in the treatment of unicoronal craniosynostosis orbital dysmorphology

  • Original Article
  • Published:
Oral and Maxillofacial Surgery Aims and scope Submit manuscript

Abstract

Purpose

The purpose of our study was to improve the minor asymmetries of fronto-orbital advancement (FOA) by introducing a simple model to guide the FOA in unicoronal synostosis which may help saving time and cost.

Methods

A retrospective analysis of 16 consecutive patients with unicoronal synostosis corrected by FOA guided by a guide model. Patients with syndromic craniosynostosis or associated craniofacial anomalies were excluded from the analysis. In all cases, 3D mirror image models were used for guiding unilateral fronto-orbital advancement. Demographic, perioperative, and follow-up data were collected for comparison. Cranial and orbital volumes were documented preoperatively and postoperatively and compared with the non-synostotic side. The postsurgical appearance of the face was documented photographically and then evaluated and scored using the Whitaker scoring system.

Results

The study included nine males and seven females. The mean age of the patients at the time of the operation was 20.4 months. The mean follow-up duration was 36 months. Mean operative time was 170 min, mean anesthetic time was 230 min, mean blood loss was 50–80 ml, and the average hospital stay was 4.4 days. No relapse that required surgical correction was reported. There were improvements in the orbital indices and volume to be near equal to the normal side. Excellent to good results were obtained in all patients according to the Whitaker classification system.

Conclusion

Residual deformity after FOA mandates another tool to optimize the results. Our study introduced a simple, easy, and applicable method to guide the FOA with lesser asymmetries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Posnick JC (1996) Unilateral coronal synostosis (anterior plagiocephaly): current clinical perspectives. Ann Plast Surg 36:430–447

    Article  CAS  PubMed  Google Scholar 

  2. Öwall L, Darvann TA, Larsen P, Hove HD, Hermann NV, Bøgeskov L, Kreiborg S (2016) Facial asymmetry in children with unicoronal synostosis who have undergone craniofacial reconstruction in infancy. Cleft Palate Craniofac J 53:385–393. https://doi.org/10.1597/15-089

    Article  PubMed  Google Scholar 

  3. Lo L-J, Marsh JL, Kane AA, Vannier MW (1996) Orbital dysmorphology in unilateral coronal synostosis. Cleft Palate Craniofac J 33:190–197. https://doi.org/10.1597/1545-1569_1996_033_0190_odiucs_2.3.co_2

    Article  CAS  PubMed  Google Scholar 

  4. Bentley RP, Sgouros S, Natarajan K, Dover MS, Hockley AD (2002) Changes in orbital volume during childhood in cases of craniosynostosis. J Neurosurg 96:747–754. https://doi.org/10.3171/jns.2002.96.4.0747

    Article  PubMed  Google Scholar 

  5. Messi M, Luzi M, Consorti G (2018) A new operative one-wing technique to correct fronto-orbital region in unilateral nonsyndromic plagiocephaly. J Craniofac Surg 29:167–169. https://doi.org/10.1097/SCS.0000000000004047

    Article  PubMed  Google Scholar 

  6. Jeyaraj P (2012) A modified approach to surgical correction of anterior plagiocephaly. J Maxillofac Oral Surg 11:358–363. https://doi.org/10.1007/s12663-011-0309-7

    Article  PubMed  Google Scholar 

  7. Bentley RP, Sgouros S, Natarajan K, Dover MS, Hockley AD (2002) Normal changes in orbital volume during childhood. J Neurosurg 96:742–746. https://doi.org/10.3171/jns.2002.96.4.0742

    Article  PubMed  Google Scholar 

  8. Wes AM, Naran S, Sun J et al (2017) The Whitaker classification of craniosynostosis outcomes: an assessment of interrater reliability. Plast Reconstr Surg 140:579e–586e. https://doi.org/10.1097/PRS.0000000000003688

    Article  CAS  PubMed  Google Scholar 

  9. Regensburg NI, Kok PHB, Zonneveld FW, Baldeschi L, Saeed P, Wiersinga WM, Mourits MP (2008) A new and validated CT-based method for the calculation of orbital soft tissue volumes. Invest Ophthalmol Vis Sci 49:1758. https://doi.org/10.1167/iovs.07-1030

    Article  PubMed  Google Scholar 

  10. Whitaker LA, Bartlett SP, Schut L, Bruce D (1987) Craniosynostosis: an analysis of the timing, treatment, and complications in 164 consecutive patients. Plast Reconstr Surg 80:195–206

    Article  CAS  PubMed  Google Scholar 

  11. Elbanoby T (2018) Craniofacial distraction in the management of anterior plagiocephaly: a novel idea and a systematic review of the literature. Pediatr Neurosurg 53:193–199. https://doi.org/10.1159/000486202

    Article  PubMed  Google Scholar 

  12. Oh AK, Wong J, Ohta E, Rogers GF, Deutsch CK, Mulliken JB (2008) Facial asymmetry in unilateral coronal synostosis: long-term results after fronto-orbital advancement. Plast Reconstr Surg 121:555–562. https://doi.org/10.1097/01.prs.0000297639.48289.9e

    Article  CAS  Google Scholar 

  13. Seruya M, Borsuk DE, Khalifian S, Carson BS, Dalesio NM, Dorafshar AH (2013) Computer-aided design and manufacturing in craniosynostosis surgery. J Craniofac Surg 24:1100–1105. https://doi.org/10.1097/SCS.0b013e31828b7021

    Article  PubMed  Google Scholar 

  14. Eufinger H, Wehmöller M, Machtens E, Heuser L, Harders A, Kruse D (1995) Reconstruction of craniofacial bone defects with individual alloplastic implants based on CAD/CAM-manipulated CT-data. J Cranio Maxillofac Surg 23:175–181. https://doi.org/10.1016/S1010-5182(05)80007-1

  15. Saber NR, Phillips J, Looi T, Usmani Z, Burge J, Drake J, Kim PCW (2012) Generation of normative pediatric skull models for use in cranial vault remodeling procedures. Childs Nerv Syst 28:405–410. https://doi.org/10.1007/s00381-011-1630-7

    Article  PubMed  Google Scholar 

  16. Burge J, Saber NR, Looi T, French B, Usmani Z, Anooshiravani N, Kim P, Forrest C, Phillips J (2011) Application of CAD/CAM prefabricated age-matched templates in cranio-orbital remodeling in craniosynostosis. J Craniofac Surg 22:1810–1813. https://doi.org/10.1097/SCS.0b013e31822e8045

    Article  PubMed  Google Scholar 

  17. Khechoyan DY, Saber NR, Burge J, Fattah A, Drake J, Forrest CR, Phillips JH (2014) Surgical outcomes in craniosynostosis reconstruction: the use of prefabricated templates in cranial vault remodelling. J Plast Reconstr Aesthet Surg 67:9–16. https://doi.org/10.1016/j.bjps.2013.09.009

    Article  PubMed  Google Scholar 

  18. Beckett JS, Persing JA, Steinbacher DM (2013) Bilateral orbital dysmorphology in unicoronal synostosis. Plast Reconstr Surg 131:125–130. https://doi.org/10.1097/PRS.0b013e3182729ed7

    Article  CAS  PubMed  Google Scholar 

  19. Ghosh TD, Skolnick G, Nguyen DC, Sun H, Patel K, Smyth MD, Woo AS (2014) Calvarial thickness and diploic space development in children with sagittal synostosis as assessed by computed tomography. J Craniofac Surg 25:1050–1055. https://doi.org/10.1097/SCS.0000000000000762

    Article  PubMed  Google Scholar 

  20. Yáñez-Vico RM, Iglesias-Linares A, Torres-Lagares D, Gutiérrez-Pérez JL, Solano-Reina E (2011) Three-dimensional evaluation of craniofacial asymmetry: an analysis using computed tomography. Clin Oral Investig 15:729–736. https://doi.org/10.1007/s00784-010-0441-7

    Article  PubMed  Google Scholar 

  21. Magge KT, Magge SN, Keating RF, Myseros JS, Boyajian MJ, Sauerhammer TM, Rogers GF, Oh AK (2014) Incidental findings on preoperative computed tomography for nonsyndromic single suture craniosynostosis. J Craniofac Surg 25:1327–1330

    Article  PubMed  Google Scholar 

  22. Suchyta MA, Gibreel W, Hunt CH, Gorny KR, Bernstein MA, Mardini S (2018) Using black bone magnetic resonance imaging in craniofacial virtual surgical planning: a comparative cadaver study. Plast Reconstr Surg 141:1459–1470

    Article  CAS  PubMed  Google Scholar 

  23. Ernst CW, Hulstaert TL, Belsack D, Buls N, van Gompel G, Nieboer KH, Buyl R, Verhelle F, de Maeseneer M, de Mey J (2016) Dedicated sub 0.1 mSv 3DCT using MBIR in children with suspected craniosynostosis: quality assessment. Eur Radiol 26:892–899. https://doi.org/10.1007/s00330-015-3870-5

    Article  PubMed  Google Scholar 

  24. Kaasalainen T, Palmu K, Lampinen A, Reijonen V, Leikola J, Kivisaari R, Kortesniemi M (2015) Limiting CT radiation dose in children with craniosynostosis: phantom study using model-based iterative reconstruction. Pediatr Radiol 45:1544–1553. https://doi.org/10.1007/s00247-015-3348-2

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tarek M. Elbanoby.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical acceptance

The study was accepted by the Al-Azhar University Ethical Committee in December 2011.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This work was presented as an oral presentation in the European Plastic Surgery Research Council, Romania, in 2017.

Electronic supplementary material

ESM 1

A visual abstract of the manuscript. (PNG 1870 kb)

High resolution image (TIFF 10638 kb)

ESM 2

Video demonstrates in step by step how to prepare the mirror image model from the CT scan. (MOV 14142 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elbanoby, T.M., Elbatawy, A.M., Aly, G.M. et al. 3D printing guided surgery in the treatment of unicoronal craniosynostosis orbital dysmorphology. Oral Maxillofac Surg 24, 423–429 (2020). https://doi.org/10.1007/s10006-020-00863-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10006-020-00863-6

Keywords

Navigation