Bilateral Orbital Dysmorphology in Unicoronal Synostosis

Background: Orbital dysmorphology is believed to cause ipsilateral ocular abnormalities in unicoronal synostosis. Recently, there has been increasing evidence of visual problems in the contralateral eye. The purpose of this study was to explore morphology of both the ipsilateral and contralateral unicoronal synostosis orbit. Methods: Demographic data and computed tomographic information were recorded. Three-dimensional computed tomographic renderings were created digitally and analyzed (SurgiCase). Craniometric analysis was conducted for orbital volume, horizontal and vertical orbital cone angle, orbital depth, and corneal projection. Results: Twenty-one unicoronal synostosis infants and 10 matched controls were examined. The orbital volume ratio between ipsilateral and contralateral sides was 93.8 +/- 5.3 in unicoronal synostosis infants and 99.3 +/- 2.1 (p = 0.001) in the control group. The horizontal orbital cone angle of the contralateral eye was significantly greater than that of both the ipsilateral side (p < 0.0001) and the control orbits (p = 0.0011, p = 0.0004). The vertical cone angle of the ipsilateral eye was significantly greater than that of the ipsilateral (p < 0.0001) and control orbits (p = 0.0326, p = 0.0030). There was no difference in orbital depth between ipsilateral and contralateral orbits. The ipsilateral globe projected 27 percent farther past the orbital aperture than the contralateral side. There was no difference between right and left orbits of a control in any analysis. Conclusions: In addition to ipsilateral orbital deformity, the contralateral orbit is highly dysmorphic. As orbital asymmetry may underlie visual abnormalities, future reconstructive efforts may necessitate bilateral correction. (Plast. Reconstr. Surg. 131: 125, 2013.)