Facial asymmetry in syndromic craniosynostosis patients undergoing midface surgery compared to a large general population

This study aimed to assess mean facial asymmetry (MFA) before and after midface surgery (Le Fort III, monobloc, or facial bipartition) in syndromic craniosynostosis patients and compare it to the general population. This retrospective study included 55 patients (22 Apert, 23 Crouzon, 10 craniofrontonasal dysplasia (CFNS)) with a mean age of 11.5 ± 5.5 at midface surgery, and 2304 general children from the Generation R study (ages 9 and 13 years). An automated algorithm quantified MFA from three-dimensional (3D) meshes created from preoperative CT-scans, registered to the postoperative scans, and from 3D images in the control population, generating a MFA value in millimeters to reflect the degree of asymmetry. Preoperative MFA was 2–2.5 times higher in patients than in controls, with the highest values in Apert (1.18 ± 0.36 mm), followed by CFNS (1.12 ± 0.48 mm), Crouzon (1.02 ± 0.50 mm), and controls (0.45 ± 0.10 mm at age 9 years and 0.47 ± 0.10 mm at age 13 years). Postoperatively, MFA increased in 32 patients (58.2 %) and decreased in 23 (41.2 %). MFA was higher in the study population, especially in Apert syndrome, with variability across syndromes and surgical groups. An automated framework for 3D MFA analysis was presented, aiding objective studies and understanding of facial asymmetry changes in syndromic craniosynostosis.