Frontoorbital Advancement in Non-Syndromic

Frontoorbital Advancement in Non-Syndromic

A 3D Morphometric and Volumetric
Follow Up Analysis
after Frontoorbital Advancement
in Non-Syndromic Craniosynostosis
1Markus
1
Martini, 1Mirjam Schulz, 2Andreas Röhrig, 3Jennifer Nadal,
2Martina Messing-Jünger
Clinic For Maxillo-Facial Surgery, University Hospital Bonn, Bonn, Germany
2 Pediatric Neurosurgery, Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
3 Institute For Medical Statistics, Bonn University, Bonn, Germany
Frontoorbital Advancement (FOA)
esthetical and functional correction of the frontoorbital region
objective criteria to evaluate surgical outcome
in patients with non-syndromic craniosynostosis
?
3D Morphometric Analysis
→ prospective study
to develop and evaluate possible objective follow up parameter
→ questions
stability of frontoorbital region after FOA
volumetric development after FOA
FOA - Study
n = 13 patients with non-syndromic craniosynostosis
3D-kephalometric measurement (OnyxCeph©)
based on superficial head scan (3D-Shape©, Erlangen, Germany)
measurements
pre op
3, 6 and 12 months post op
→ increase in skull volume
→ change in shape of frontoorbital advancement
Landmarks and Measuring Points
Points / Items
Description
Glabella
Gl
The most anterior midpoint of the fronto-orbital soft
tissue contour.
Preaurale
Pa
The most anterior point of the ear, located at the level
oft he helix attachment to the head
Orbitale
Or
Exocanthion
Ex
Soft tissue point located at the most inferior level of
each infraorbital rim, located at the level oft he 3-D hard
tissue cephalometric orbitale landmark
Soft tissue point located at the outer commissure of
each eye fissure
Eurion
Eu
Opisthocranion
Op
Frontotemporalpoint
right / left
Parietalpoint *
* FTPr, FTPl
Landmark defined as the most lateral point of the
parieto-temporal region of the skull (=> CI = Eur-Eul x
100 / Gl –Op)
Landmark defined as the most posterior point of the
occipital region of the head and the most distant from
glabella
Soft tissue point located in the horizontal plane which is
parallel to the Frankfurt horizontal plane and comprise
the glabella. The point drop perpendicular to the left
respectively right exocanthion and project onto the
surface (generated by OnyxCeph©-software)
PAr, PAl
Soft tissue point located in the horizontal plane which is
parallel to the Frankfurt horizontal plane and comprise
the glabella. The point drop perpendicular to the left
respectively right preaurale and project onto the surface
(generated by OnyxCeph©-software)
FTPrGlFTPl
Angle between left frontotemporal point, Glabella and
right frontotemporal point
Right frontalparietal angle PARFTPrGl
Angle between right parietal point, right frontotemporal
point and glabella
Left frontalparietal angle
PALFTPlGL
Angle between left parietal point, left frontotemporal
point and glabella
FOA Cross line 1
Par/l – FTPl/r
Longest distance between parietalpoint right /left and
frontotemporal point left /right
FOA Cross line 2
Par/l – FTPl/r
Shorter distance between parietalpoint right /left and
frontotemporal point left / right
right / left
frontal angle
Definition of landmarks
and measuring points
to determine the
frontoorbital bandeau changes
Points are basing on
soft tissue landmarks
of facial surface
Swennen GRJ: 3-D cephalometric soft tissue
landmarks. In: Swennen GRJ, Schutyser F, Hausamen
JE, Hrgs. Three-Dimensional Cephalometry: A Color
Atlas and Manual. Berlin – Heidelberg - New York:
Springer Verlag 186-234, 2006
* newly defined points
Scan Evaluation
Soft Tissue Landmarks
Soft tissue landmarks on skin surface (left side)
Gl (glabella), Or (infraortibal point), FTP (frontotemporal point), exocanthion, PA (parietal point),
Pe (preaural point)
Measuring Points – Specific FOA Angles
frontal angle
FTPrGlFTPl
Angle between left frontotemporal
glabella and right frontotemporal point
point,
Right frontalparietal PARFTPrGl
angle
Angle between right parietal point, right
frontotemporal point and glabella
Left frontalparietal PALFTPlGL
angle
Angle between left parietal
frontotemporal point and glabella
point,
left
Development of Frontal Angle after FOA
boxplots of frontal angle development
Development of Frontoparietal Angle after FOA (r)
Development of Frontoparietal Angle after FOA (l)
Development of Skull Volume after FOA
boxplots of skull volume measurements
Results
13 patients
trigonocephalic 7
anterior plagiocephalic 4
brachycephalic 2
postoperative angle measures in all subgroups
frontal angle
→ constantly 145° (median) after 3, 6 and 12 months
frontoparietal angle (L/R) → between 137° and 140° (stable)
skull volume assessment
brachycephalic
plagiocephalic
trigonocephalic
initial skull sizes
984 cm3
1205 cm3
1214 m3
after 12 months
1340 cm3
1598 cm3
1596 cm3
Conclusion
During the 12 months follow FOA angle parameters proved to be stable
No major impairment of harmonic skull growth could be observed
The frontoorbital angle is a useful parameter to evaluate longterm esthetical
outcome
The frontoparietal angle is important for the stability of the frontoparietal
region, in which a certain growth inhibition has been discussed in former series
The classical FOA technique does not inhibit a constant increase in skull
volume although brachycephalic children have a significantly lower volume
Thank you !