Evaluation of long-term aesthetic outcomes of fronto-orbital advancement using a crossing-the-midline greenstick fracture technique in anterior synostotic plagiocephaly.

objectiveAnterior synostotic plagiocephaly (ASP), resulting from premature fusion of the unilateral coronal suture, leads to craniofacial asymmetry and potential functional impairment. While fronto-orbital symmetry and intracranial pressure management are key surgical goals, long-term aesthetic outcomes remain insufficiently explored. This study presents a novel technique utilizing a crossing-the-midline greenstick fracture of the supraorbital bar for unilateral fronto-orbital remodeling and evaluates its aesthetic results.

methodsA retrospective review was conducted of 51 patients with isolated, non-syndromic anterior plagiocephaly who underwent unilateral fronto-orbital advancement using this technique between 2010 and 2023. Outcomes were assessed using the Whitaker classification by an independent surgical team, and outcomes were analyzed statistically to determine associations with patient variables, including age at surgery.

resultsThe majority of patients achieved favorable aesthetic outcomes, with 70.6% rated as Whitaker grade I (no revision required). Only four patients were classified as Whitaker III, and none as Whitaker IV. Higher Whitaker grades were significantly associated with older age at surgery (P = 0.007). No major complications or reoperations were reported related to the greenstick fracture technique.

conclusionsThis study presents the first clinical evaluation of a technique for treating ASP involving a crossing-the-midline greenstick fracture applied to the supraorbital bar. This method is associated with favorable long-term aesthetic outcomes and may reduce the need for midline fixation hardware. These findings suggest that this approach could be a safe and practical alternative to traditional methods, especially in areas with limited resources.