Changes in facial symmetry after posterior hemivertebra resection in children with congenital cervicothoracic/upper thoracic scoliosis

English Keywords:Congenital scoliosis  Cervicothoracic/upper thoracic scoliosis  Hemivertebra resection  Facial asymmetry

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical outcomes of posterior-only hemivertebra resection in patients with congenital cervicothoracic/upper thoracic scoliosis and facial asymmetry, and to analyze the improvement of facial symmetry during follow-up. Methods: Patients with congenital cervicothoracic/upper thoracic scoliosis, who received posterior-only hemivertebra resection and correction operation in our hospital from June 2010 to January 2019 were retrospectively analyzed. A total of 16 patients(7 males and 9 females) with an average age of 8.1±3.2 years were enrolled in this study. The radiographic parameters including local scoliosis, local kyphosis, clavicle angle, T1 tilt, neck tilt, and head shift were assessed preoperatively, postoperatively and at the last follow-up. The bone markers including laterosuperiot point, zygomatic point, maxillary point, gonion point and mental tubercles were marked on posterior-anterior cephalgram preoperatively and at the last follow-up. The facial soft tissue marker involving the outer canthus point, zygomatic point, gonion point and mental tubercles were marked on anterior facial images preoperatively and at the last follow-up. The asymmetry ratio between the distance planes on both sides to the midline of the above marker points was measured respectively. The paired t test was used for comparative analysis between groups. Results: The mean postoperative follow-up period was 33.3±8.7 months(range, 24－49 months), and the mean fusion levels were 7.8±1.2 levels(range, 5－10 levels). The local scoliosis, local kyphosis, T1 tilt, clavicle angle, neck tilt and head shift were significantly improved after operation(P<0.05 for all). The preoperative asymmetry rates of bone markers of maxillary point, gonion point and mental tubercles were (6.12±1.13)%, (8.73±5.53)% and (25.80±10.41)%, respectively, which were (4.30±0.66)%, (1.32±0.35)% and (5.52±1.38)% at the last follow-up(P<0.05). The bone markers of laterosuperiot point and zygomatic point were both ＜5% preoperatively and at the last follow-up, which were within the normal range. The asymmetry rates of soft tissue of zygomatic point, gonion point and mental tubercles were (10.41±4.38)%, (16.63±5.32)% and (46.82±13.3)% at preoperation, and (2.18±0.91)%, (4.38±3.83)% and (8.72±4.41)% at the last follow-up(P<0.05). The facial soft tissue marker of outer canthus point was (3.83±0.96)% preoperatively and (2.26±0.38)% at the last follow-up, which were within the normal range. Conclusions: For children with congenital cervicothoracic/upper thoracic scoliosis, posterior hemivertebra resection and correction surgery can correct the local scoliosis, and restore head-neck-shoulder balance. Spontaneous improvement of facial asymmetry can also be observed during longitudinal follow-up.