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How Does The Bandeau Grow: Quantifying Post-operative Changes In The Bandeau Over Time After Fronto-orbital Advancement
Lucas A. Dvoracek, MD1, Aaron Foglio, BA1, Sean Herman, MD1, Eva Roy, BA1, Rosaline Zhang, MD2, Scott P. Bartlett, MD2, Joseph E. Losee, MD1, Jesse A. Taylor, MD2, Jesse A. Goldstein, MD1.
1University of Pittsburgh, Pittsburgh, PA, USA, 2University of Pennsylvania, Philadelphia, PA, USA.

PURPOSE: Temporal hollowing is a late sequelae of fronto-orbital advancement (FOA) surgeries. Bony manipulation including devascularization and under-correction may contribute to temporal hollowing. We sought to objectively assess how such bony morphology changes over time.
METHODS: A multi-center, retrospective study identified craniosynostosis (CS) patients treated with FOA between 2008-2018 with both early and late (>12 mos) post-operative head CT scans. Scans were reconstructed, oriented, and manually segmented into surgical fragments that delineated the osteotomies of interest for a given patient. 32 data points and 35 discreet metrics were collected from each patient and evaluated for changes over time.
RESULTS: Twenty patients matched inclusion criteria (12 female:8 male). CS subtypes included metopic (7), unilateral coronal (6 right, 3 left), and other (4). Mean age at surgery and time to follow-up scan was 1.4 and 2.8 years respectively. Average biparietal growth was 1.2% per year*. While average bandeau bitemporal width increased 2.0% per year*, anterior width decreased by about 1% per year, while the midface appeared to grow normally 2.3% per year, leading to an anterior transverse deficiency. While the anteroposterior length of the bandeau increased 1.3% per year*, the lateral orbital and temporal regions collapsed posteriorly at 2% per year*, further accentuating deficiencies in this area. Data was significant by paired t-test (*).
CONCLUSION: The long-term shape and position of the bandeau determines surgical success of FOA. We found that the skull continues to widen bitemporally after surgery, however widening at the anterior temporal region of the bandeau is negligible, and this region undergoes remodeling which further diminishes projection to the rest of the skull. This is the first comparative demonstration of the bony contribution toward temporal hollowing in early and late post-operative patients.


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