Background: Synostotic frontal plagiocephaly (SFP) results in facial asymmetry. Fronto-orbital advancement (FOA) corrects the forehead and orbital asymmetries, but does not address the misalignment of the middle and lower face. While there are several reports documenting long-term symmetry of the upper face following FOA for SFP, little has been written about asymmetry of the middle and lower face. Purpose: To describe lower two-third facial asymmetry in adolescent and adult patients after FOA for SFP in infancy. Patients/Methods: 3-dimensional digital photogrammetric images were acquired (3dMDface System) and the following anthropometric measurements were made: right and left endocanthion-facial midline distance (endocanthion [en] to sellion [se]); right and left middle facial length (tragion [t] to subnasale [sn]); right and left lower facial length (tragion [t] to gnathion [gn]); nasal tip deviation (sellion [se] to pronasale [prn]); and facial midline deviation (sellion [se] – subnasale [sn] – gnathion [gn]). Results: The average age at FOA was 8 months (range: 3 - 14 months). 3dMD digital images were obtained on fourteen patients, average age 14.2 years (range: 11 - 29 years). Digital anthropometry demonstrated decreased middle facial length on average 5.7 +/- 2.7 mm (p<0.0001) and lower facial length on average 3.2 +/- 2.1 mm (p<0.0001) on the side of synostosis. Moreover, nasal tip deviation to the contralateral side was on average 5.0 +/- 1.4 degrees and facial midline deviated to the contralateral side on average 3.4 +/- 0.7 degrees. This contralateral rotation of the middle and lower face was consistent in all 14 patients (chi square analysis p<0.0001 for both nasal tip and facial midline deviation). In general, neither age at FOA nor age at digital imaging correlated with middle and lower facial asymmetry, although there was significant correlation between age at digital imaging and lower facial depth (Pearson Product Moment Correlation Coefficient, r = 0.67, p<0.01). Conclusions: Despite FOA for SFP during infancy, adolescent and adult patients have persistent middle and lower facial asymmetry. This is the result of decreased ipsilateral facial length and consistent contralateral rotation.
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