Background: The optimal strategy for correction of significant nasal angulation in patients with unilateral coronal synostosis remains controversial. The authors report a novel technique for correction of significant nasal angulation in these patients, in which dissection of the nasal bones is limited to the site of the osteotomy, maintaining continuity with the soft-tissue envelope and the nasal cartilages.
Methods: Seven successive patients with unilateral coronal synostosis and nasal deviation of greater than 6 degrees by computed tomographic analysis were evaluated. Three patients were treated using ex vivo repositioning in which the nasal bones were freed completely from the surrounding soft-tissue envelope, and four patients were treated with in vivo repositioning by performing a subperiosteal dissection only where required for lateral nasal osteotomies without separating the nasal bones from the cartilaginous framework of the nose. Nasal angulation was calculated using clinical photographs and three-dimensional computed tomography preoperatively and at 1-year follow-up.
Results: Mean nasal angulation was reduced from 9.5 degrees to 2.5 degrees by computed tomographic analysis (p<0.001) and from 6.9 degrees to 1.9 degrees by photographic analysis (p<0.01) 1 year postoperatively. There was no significant difference in outcome between patients who underwent ex vivo or in vivo repositioning.
Conclusions: Primary surgical correction of significant nasal angulation in patients with unilateral coronal synostosis can be achieved with less dissection and disruption of soft-tissue relationships than previously described without compromise in efficacy. The authors' technique for osteotomy of the nasal bones preserves nasal architecture, minimizes periosteal dissection, and may theoretically reduce the potential for growth disruption.
Clinical question/level of evidence: Therapeutic, IV.