A three-dimensional smooth surface analysis of untreated Crouzon's syndrome in the adult.

This study compares the three-dimensional smooth surface shape of five adult patients with Crouzon's disease with nine normal skulls. A new analysis method is described which is based on smooth surface curvature. Surface samples are subdivided by a common ridge curve structure. Three-dimensional images of an average normal and an average Crouzon skull are illustrated. Comparisons between groups are performed on landmarks, as well as ridge curve and surface patch midpoints. There was as much discriminant information in the ridge curves and surface patches between landmarks as there was at the landmarks themselves. When compared with normal samples, the Crouzon's syndrome sample exhibits the following major characteristics: The midface is concave and wide, with the piriform aperture in the center more recessed than the perifery of the midface. The forehead is recessed above a frontal sinus bulge. The orbits are shallow, wide, concave, and tilted inferiorly with a mild hypertelorism. These data suggest that advancement of large, one-piece osteotomy segments will not produce a normal face, and a multisegment approach should be considered.