Euclidean Distance Matrix Analysis of Surgical Changes in Prepubertal Craniofacial Microsomia Patients Treated with an Inverted L Osteotomy

Abstract

Objectives

Correction of craniofacial microsomia (CFM) presents several challenges concerning the modality of surgical intervention. The aim of this study was to assess early and late surgical outcome, by undertaking Euclidean distance matrix analysis (EDMA) of CFM patients exhibiting an unilateral mandibular deformity that was surgically corrected by an inverted L osteotomy and autogenous bone graft.

Design

Longitudinal study. Preoperative, ≈1-year postoperative and ≈3-year postoperative assessments of 14 consecutive children (mean age 9 years) with CFM. Posteroanterior cephalographs were scanned and five homologous mandibular landmarks were digitized in triplicate (< 1% digitization error). Average mandibular geometries, scaled to an equivalent size, were generated using a generalized rotational fit program (Procrustes superimposition) and subjected to EDMA.

Results

The mean pre- and both postoperative mandibular configurations differed statistically (p < .01). Early postoperative improvements in mandibular form were noted; increases in length arising in the treated mandibular body (≈ 19%) and ramus (≈ 13%). Comparing early and late postoperative configurations, a decrease of ≈ 22% in the late postoperative mandibular body length was evident, but the ramus maintained steady vertical growth (≈ 7%). Comparing the preoperative and late postoperative configurations, the decrease observed in the mandibular body on the treated side was reduced to ≈ 8% while the ramus maintained good growth (≈ 20%) on that side.

Conclusion

Mandibular morphology is improved significantly in CFM patients surgically treated by an inverted L osteotomy, but relapse in the mandibular body is evident after ≈ 3 years. Nevertheless, ramus growth proceeds well after the surgical reconstruction.