Variations in orbital morphology, globe:orbit volume relation, and ophthalmological outcome in unicoronal synostosis
DOI:
https://doi.org/10.2340/jphs.v59.42322Keywords:
Nonsyndromic unicoronal synostosis, surgical outcome, ophthalmological outcome, orbital symmetry, globe volume, imagingAbstract
Nonsyndromic unicoronal synostosis is associated with variability of severity in orbital morphology and ophthalmological manifestations. The relation between the two is not fully understood, nor how surgical treatment with fronto-orbital advancement and remodelling (FOAR) changes the relation. The aim of this study was to elucidate associations between ophthalmological manifestations and variations in orbital morphology and globe:orbit volume ratios preoperatively and at long-term follow-up after surgery. Twelve children referred to Uppsala Craniofacial Center who underwent computed tomography and standardized ophthalmological examinations regarding strabismus, spherical equivalent, astigmatism, anisometropia, and subnormal vision preoperatively and at 3 years of age were included. Orbits and globes were segmented. Principal component analysis elucidated morphological variation, and symmetry between orbital pairs was measured as the Dice similarity coefficient and globe:orbit volume ratios were calculated. The defined orbital shape variations were correlated with strabismus, refractive error, and subnormal vision. Different shape variations were associated with strabismus pre- and postoperatively and ipsi- and contralateral astigmatism. Greater improvement in orbital symmetry after surgery was associated with improvement in astigmatic anisometropia and new onset strabismus at follow-up. A small globe:orbit volume ratio was associated with preoperative strabismus, while the opposite was seen at follow-up. Different mechanisms seem to cause strabismus pre- and postoperatively, and FOAR might not sufficiently correct orbital morphology.
Downloads
References
Touzé R, Paternoster G, Arnaud E, et al. Ophthalmological findings in children with unicoronal craniosynostosis. Eur J Ophthalmol. 2022;32(6):3274–3280. https://doi.org/10.1177/11206721221077548 DOI: https://doi.org/10.1177/11206721221077548
Ntoula E, Nowinski D, Holmstrom G, et al. Ophthalmological findings in children with non-syndromic craniosynostosis: preoperatively and postoperatively up to 12 months after surgery. BMJ Open Ophthalmol. 2021;6(1):e000677. https://doi.org/10.1136/bmjophth-2020-000677 DOI: https://doi.org/10.1136/bmjophth-2020-000677
Di Rocco C, Paternoster G, Caldarelli M, et al. Anterior plagiocephaly: epidemiology, clinical findings, diagnosis, and classification: a review. Childs Nerv Syst. 2012;28(9):1413–1422. https://doi.org/10.1007/s00381-012-1845-2 DOI: https://doi.org/10.1007/s00381-012-1845-2
Luo W-T, Chen X, Zhang Y-D, et al. Ophthalmological outcomes of unilateral coronal synostosis in young children. BMC Ophthalmol. 2020;20(1):318. https://doi.org/10.1186/s12886-020-01547-1 DOI: https://doi.org/10.1186/s12886-020-01547-1
Levy RL, Rogers GF, Mulliken JB, et al. Astigmatism in unilateral coronal synostosis: incidence and laterality. J AAPOS. 2007;11(4):367–372. https://doi.org/10.1016/j.jaapos.2007.02.017 DOI: https://doi.org/10.1016/j.jaapos.2007.02.017
Samra F, Paliga JT, Tahiri Y, et al. The prevalence of strabismus in unilateral coronal synostosis. Childs Nerv Syst. 2015;31(4):589–596. https://doi.org/10.1007/s00381-014-2580-7 DOI: https://doi.org/10.1007/s00381-014-2580-7
Gencarelli JR, Murphy A, Samargandi OA, et al. Ophthalmologic outcomes following fronto-orbital advancement for unicoronal craniosynostosis. J Craniofac Surg. 2016;27(7):1629–1635. https://doi.org/10.1097/SCS.0000000000003085 DOI: https://doi.org/10.1097/SCS.0000000000003085
Ntoula E, Nowinski D, Holmström G, et al. Strabismus and refraction in non-syndromic craniosynostosis – a longitudinal study up to 5 years of age. Acta Ophthalmol. 2024;102(5):564–572. https://doi.org/10.1111/aos.16605 DOI: https://doi.org/10.1111/aos.16605
Yu JW, Xu W, Wink JD, et al. Strabismus in unicoronal craniosynostosis: effect of orbital dysmorphology and fronto-orbital advancement and remodeling. Plast Reconstr Surg.2020;145(2):382e–390e.https://doi.org/10.1097/PRS.0000000000006479 DOI: https://doi.org/10.1097/PRS.0000000000006479
Villavisanis DF, Blum JD, Cho DY, et al. Long-term aesthetic and photogrammetric outcomes in non-syndromic unicoronal synostosis: comparison of fronto-orbital distraction osteogenesis and fronto-orbital advancement and remodeling. Childs Nerv Syst. 2023;39(5):1283–1296. https://doi.org/10.1007/s00381-023-05857-9 DOI: https://doi.org/10.1007/s00381-023-05857-9
Alford J, Derderian CA, Smartt JM, Jr. Surgical treatment of nonsyndromic unicoronal craniosynostosis. J Craniofac Surg. 2018;29(5):1199–1207. https://doi.org/10.1097/SCS.0000000000004509 DOI: https://doi.org/10.1097/SCS.0000000000004509
Elhusseiny AM, MacKinnon S, Zurakowski D, et al. Long-term ophthalmic outcomes in 120 children with unilateral coronal synostosis: a 20-year retrospective analysis. J AAPOS. 2021;25(2):76.e1–76.e5. https://doi.org/10.1016/j.jaapos.2020.10.013 DOI: https://doi.org/10.1016/j.jaapos.2020.10.013
Lif, H. M., Nysjö, J. E., Vegelius, J. R., Unander-Scharin, J., Enblad, P., & Nowinski, D. J. (2023). Persistent discrepancies in orbital morphology after surgical treatment of unicoronal craniosynostosis: a critical image-based analysis. Journal of neurosurgery. Pediatrics, 1–10. Advance online publication. https://doi.org/10.3171/2023.1.PEDS22349 DOI: https://doi.org/10.3171/2023.1.PEDS22349
Levasseur J, Nysjö J, Sandy R, et al. Orbital volume and shape in Treacher Collins syndrome. J Craniomaxillofac Surg. 2018;46(2):305–311. https://doi.org/10.1016/j.jcms.2017.11.028 DOI: https://doi.org/10.1016/j.jcms.2017.11.028
Khonsari RH, Hennocq Q, Nysjö J, et al. Defining critical ages for orbital shape changes after frontofacial advancement in crouzon syndrome. Plast Reconstr Surg. 2019;144(5):841e–852e. https://doi.org/10.1097/PRS.0000000000006162 DOI: https://doi.org/10.1097/PRS.0000000000006162
Bellaire CP, Devarajan A, Napoli JG, et al. Craniofacial dysmorphology in infants with non-syndromic unilateral coronal craniosynostosis. J Craniofac Surg. 2022;33(6):1903–1908. https://doi.org/10.1097/SCS.0000000000008464 DOI: https://doi.org/10.1097/SCS.0000000000008464
Ramdat Misier KRR, Breakey RWF, van de Lande LS, et al. Correlation between head shape and volumetric changes following spring-assisted posterior vault expansion. J Craniomaxillofac Surg. 2022;50(4):343–352. https://doi.org/10.1016/j.jcms.2021.05.004 DOI: https://doi.org/10.1016/j.jcms.2021.05.004
Pluijmers BI, Ponniah AJ, Ruff C, et al. Using principal component analysis to describe the Apert skull deformity and simulate its correction. J Plast Reconstr Aesthet Surg. 2012;65(12):1750–1752. https://doi.org/10.1016/j.bjps.2012.07.007 DOI: https://doi.org/10.1016/j.bjps.2012.07.007
Srivilasa C, Zhao L, Patel PK, et al. Statistical shape analysis of metopic craniosynostosis: a preliminary study. Conf Proc IEEE Eng Med Biol Soc. 2006;2006:4066–4069. https://doi.org/10.1109/IEMBS.2006.260032 DOI: https://doi.org/10.1109/IEMBS.2006.260032
Staal FC, Ponniah AJ, Angullia F, et al. Describing Crouzon and Pfeiffer syndrome based on principal component analysis. J Craniomaxillofac Surg. 2015;43(4):528–536. https://doi.org/10.1016/j.jcms.2015.02.005 DOI: https://doi.org/10.1016/j.jcms.2015.02.005
Way BLM, Khonsari RH, Karunakaran T, et al. Correcting exorbitism by monobloc frontofacial advancement in Crouzon-Pfeiffer syndrome: an age-specific, time-related, controlled study. Plast Reconstr Surg. 2019;143(1):121e–132e. https://doi.org/10.1097/PRS.0000000000005105 DOI: https://doi.org/10.1097/PRS.0000000000005105
Nysjö J. Interactive 3D image analysis for cranio-maxillofacial surgery planning and orthopedic applications. Acta Universitatis Upsaliensis; 2016.
Yushkevich PA, Piven J, Hazlett HC, et al. User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage. 2006;31(3):1116–1128.https://doi.org/10.1016/j.neuroimage.2006.01.015 DOI: https://doi.org/10.1016/j.neuroimage.2006.01.015
Hoppe IC, Taylor JA. A cohort study of strabismus rates following correction of the unicoronal craniosynostosis deformity: conventional bilateral fronto-orbital advancement versus fronto-orbital distraction osteogenesis. J Craniofac Surg. 2021;32(7):2362–2365. https://doi.org/10.1097/SCS.0000000000007773 DOI: https://doi.org/10.1097/SCS.0000000000007773
Mayer DL, Hansen RM, Moore BD, et al. Cycloplegic refractions in healthy children aged 1 through 48 months. Arch Ophthalmol. Uppsala. 2001;119(11):1625–1628. https://doi.org/10.1001/archopht.119.11.1625 DOI: https://doi.org/10.1001/archopht.119.11.1625
Macintosh C, Wall S, Leach C. Strabismus in unicoronal synostosis: ipsilateral or contralateral? J Craniofac Surg. 2007;18(3):465–469. https://doi.org/10.1097/scs.0b01e3180515d94 DOI: https://doi.org/10.1097/scs.0b01e3180515d94
Song HB, Yang HK, Baek RM, et al. Effect of fronto-orbital advancement on astigmatism in patients with anterior plagiocephaly. J Craniomaxillofac Surg. 2016;44(10):1504–1507. https://doi.org/10.1016/j.jcms.2016.04.028 DOI: https://doi.org/10.1016/j.jcms.2016.04.028
Tarczy-Hornoch K, Smith B, Urata M. Amblyogenic anisometropia in the contralateral eye in unicoronal craniosynostosis. J AAPOS. 2008;12(5):471–476. https://doi.org/10.1016/j.jaapos.2008.03.008 DOI: https://doi.org/10.1016/j.jaapos.2008.03.008
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Hanna M. Lif, Evangelia Ntoula, Eva Larsson, Daniel J. Nowinski
This work is licensed under a Creative Commons Attribution 4.0 International License.
Acta Chirurgica Scandinavica Society owns the copyright for all material published until Volume 57 (2023) unless otherwise specified. As from 2024 all published articles, unless otherwise specified, are published under CC-BY licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work.
