Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Successful surgical repair of unicoronal plagiocephaly remains a challenge for craniofacial surgeons. Many of the surgical techniques directed at correcting the stigmata associated with this craniofacial deformity (for example, ipsilateral supraorbital rim elevation [vertical dystopia], ipsilateral temporal constriction, C-shaped deformity of the face, and so on) are not long lasting and often result in deficient correction and the need for secondary revision surgery. The authors posit that the cause of this relapse was intrinsic deficiencies of the current surgical techniques. The aim of this study was to determine if correction of unilateral coronal plagiocephaly with a novel hypercorrection surgical technique could prevent the relapse of the characteristics associated with unicoronal plagiocephaly.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors performed a retrospective analysis of 40 consecutive patients who underwent surgical repair of unicoronal plagiocephaly at their institution between 1999 and 2009. In all cases, the senior author (S.R.B.) used a hypercorrection technique for surgical reconstruction. Hypercorrection consisted of significant overcorrection of the affected ipsilateral frontal and anterior temporal areas in the sagittal and coronal planes. Demographic, perioperative, and follow-up data were collected for comparison. The postsurgical appearance of the forehead was documented clinically and photographically and then evaluated and scored by 2 independent graders using the expanded Whitaker scoring system. A relapse was defined as a recurrence of preoperative features that required secondary surgical correction.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The mean age of the patients at the time of the operation was 13 months (range 8–28 months). The mean follow-up duration was 57 months (range 3 months to 9.8 years). The postsurgical hypercorrection appearance persisted on average 6–8 months but gradually dissipated and normalized. No patients exhibited a relapse of unicoronal plagiocephalic characteristics that required surgical correction. In all cases the aesthetic results were excellent. Only 3 patients required reoperation for the management of persistent calvarial bone defects (2 cases) and removal of a symptomatic granuloma (1 case).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Our study demonstrates that patients who undergo unicoronal plagiocephaly repair with a hypercorrection surgical technique avoid long-term relapse. Our results suggest that the surgical technique used in the correction of unilateral coronal synostosis is strongly associated with the prevention of postsurgical relapse and that the use of this novel method decreases the need for surgical revision.</jats:p></jats:sec>

Photometric evaluation of cranial and facial symmetry in hemicoronal single suture synostosis treated with surgical fronto-orbital remodeling

“…An overcorrection of about 20% of the controlateral profile is advisable (Mesa et al, 2011). It is important to note that, this way, on the affected side, the range of bony advancement of the superolateral orbital frame was 16 to 23 mm.…”

Anteriorna plagiocefalija – Prikaz primera in opis kirurške tehnike

“…Optimalni čas operacije je sicer po opisih v literaturi še vedno vir razprav. Po mnenju večine avtorjev je poseg najbolje opraviti med šestim in dvanajstim mesecem starosti (10)(11)(12)(13). Poseg pred to starostjo je nevaren zaradi možne velike izgube krvi ter zaradi večje možnosti recidiva kraniosinostoze (11,13).…”

“…Gre za princip, po katerem so dolgoročni estetski rezultati boljši, če se preoblikovani bandeau na prizadeti strani pričvrsti v bolj anteriornem in inferiornem položaju v primerjavi z neprizadeto stranjo, se pravi, da se hiperkorekcija opravi v transverzalni, koronarni in v sagitalni ravnini (11,13). Taka tehnika zmanjšuje dolgoročno temporalno zoženje kraniosinostotične strani in možnost ponovitve sinostoze.…”

Management of Craniosynostosis

“…Typical dysmorphic appearance is called anterior plagiocephaly and includes flattening of the ipsilateral forehead, elevation of the supraorbital rim on the affected side, deviation of the nasal root to the ipsilateral side, contralateral forehead, and temporal bossing. 18,37 Fig. 4 Unilateral lambdoid craniosynostosis.…”