CRITICAL ANALYSIS OF RESULTS OF CRANIOFACIAL SURGERY FOR NONSYNDROMICBICORONAL SYNOSTOSIS

We retrospectively assessed the intermediate and long-term results of craniofacial surgery in 22 consecutive patients with nonsyndromic bico ronal synostosis to determine the outcome of corrective surgery. The s tudy population consisted of 13 males and 9 females whose ages ranged from 6 weeks to 24 months (mean, 5.6 months) at the time of initial su rgery. All patients had been assigned a diagnosis of nonsyndromic bico ronal synostosis. Each patient underwent resection of both coronal sut ures and frontal orbital advancement with cranial vault remodeling usi ng a floating forehead technique. Age at initial operation was 5 month s or less in 13 patients and 6 months or more in 9. Complications occu rred in 5 patients (23%), and 1 patient with an associated metabolic d isorder died from respiratory arrest postoperatively. Follow-up ranged from 6 to 168 months (mean, 53.2 months). Results were graded accordi ng to the need for and extent of reoperation. Residual aesthetic defor mities were documented in 12 patients (55%). Three patients (14%) requ ired calvarial recontouring or cranioplasty to achieve satisfactory fo rehead contour or bony continuity. Total reoperation for recurrent def ormity was required at a mean age of 29.7 months in 8 patients (36%) a nd is pending in another (4%). Four patients (18%) required a third op eration (two total reoperations and two cranioplasties) to achieve sat isfactory results. Eight of 13 patients (62%) operated on at 5 months of age or younger required total reoperation compared with 1 of 9 (11% ) operated at 6 months of age or older. When analyzed alone, age of op eration was a statistically significant determinant of the need for re operation (p < 0.03). However, when subjected to multivariate analysis , neither age at operation nor the presence of an associated anomaly o r positive family history had a significant effect on outcome.