Unilateral Versus Bilateral Fronto-Orbital Advancement in Non-Syndromic Unicoronal Craniosynostosis

BACKGROUND: Nonsyndromic unicoronal craniosynostosis (NS-UCS) is characterized by asymmetric craniofacial deformity and remains one of the most challenging entities in craniofacial surgery. Fronto-orbital advancement (FOAR) may be performed either unilaterally or bilaterally, yet the optimal approach remains controversial. The present study aims to compare surgical outcomes, complication profiles, and long-term stability between unilateral and bilateral FOAR to clarify selection criteria for surgical technique. METHODS: A systematic review was conducted using the PubMed, Web of Science, and Cochrane databases, following PRISMA guidelines. Studies involving nonsyndromic anterior plagiocephaly treated by unilateral or bilateral FOAR with ≥12 months of follow-up were included. Twenty studies encompassing 511 patients met the inclusion criteria. Data were pooled, and statistical analyses were performed using (IBM SPSS Statistics version 29.0; IBM Corp., Armonk, NY) and Python-based analytical tools. RESULTS: Of the included patients, 315 (61.6%) underwent bilateral FOAR and 196 (38.4%) underwent unilateral FOAR. Contour deformity was significantly more frequent after unilateral FOAR (75.0% vs. 27.5%, P