Orthognathic surgery in syndromic craniosynostosis: Incorporating midface morphometric analysis and dental parameters in surgical planning

Syndromic craniosynostosis (SC) is a complex craniofacial anomaly secondary to premature fusion of cranial sutures. Early surgical interventions are primarily indicated to address various functional issues arising from the associated structural abnormalities rather than cosmetic reason. Despite early surgical intervention, midface and jaw discrepancy are common clinical presentation among SC children that would necessitate orthognathic surgery in later stage. This study was conducted with the aim to analyse the midface and identify important skeletal and dental parameters among SC children that may influence the indications of orthognathic surgery. This study involved 10 children diagnosed with SC. Other than clinical assessment, patients’ records and CT scans were analyzed. Data categories include demography, previous and existing functional issues, surgical history, orthodontic parameters, dental status, current intervention and morphometric analysis of midface and skull base using various anatomical landmarks. A matching control (n=10) was included for CT scan analysis. All SC children (n=10) presented with functional issues and had undergone surgical intervention. Most SC children were presented with midface hypoplasia (n=7) and Class III skeletal pattern (n=6). All SC children have Class III malocclusion and maxillary transverse deficiency, with milder reversed overjet (mean=-0.6mm) and anterior open bite (mean=1.2mm) in operated children. The mean dmft score was 0.075+2.09, and mean DMFT was 0.225+1.91. Midface and skull base morphometric analysis showed N-BA, S-BA, S-PNS, S-SO, SO-BA, TP-TPR and MO-ZMs in SC children were significantly reduced (p<0.05) when compared to control group. The median length of N-ES was increased while the ZMs-ZTi was reduced in SC group as compared to control group. Midface hypoplasia with Class III skeletal pattern and malocclusion are common in SC children despite early surgical intervention. Orthognathic surgery upon growth maturity is recommended to address the skeletal discrepancy, improve residual functional issues and to achieve normal jaw relationship.