Synostotic Frontal Plagiocephaly: Anthropometric Comparison of Three Techniques for Surgical Correction

Hansen, Matthew C.; Padwa, Bonnie L.; Scott, R. Michael; Stieg, Phillip E.; Mulliken, John B.

doi:10.1097/00006534-199711000-00002

Cited by 69 publications

(47 citation statements)

References 22 publications

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“…At present, anterior plagiocephaly represents a great challenge for the craniofacial surgeon 2,14,20,21,29 . We advise to use the conventional unilateral fronto-orbital advancement with "tongue-in-groove" design in the temporal region combined with supraorbital "bandeau" in severe cases and to include nasal osteotomies if neccessary.…”

Section: Resultsmentioning

confidence: 99%

“…On the contrary, anterior plagiocephaly has always been more laborious to correct, being complications more frequent and its results difficult to predict 2,14,20,21,39 . Nevertheless, there were few complications among our patients and we did not find significant differences between the two techniques performed (Type VII: frontal bilateral remodelling without frontal-orbital "bandeau" and Type VIII: frontal bilateral remodelling with frontal-orbital "bandeau").…”

Section: Complicationsmentioning

confidence: 99%

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Surgical treatment of isolated and syndromic craniosynostosis. Results and complications in 283 consecutive cases

et al. 2008

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SummaryObjective. To review the results and complications of the surgical treatment of craniosynostosis in 283 consecutive patients treated between 1999 and 2007.Patients and methods. Our series consisted of 330 procedures performed in 283 patients diagnosed with scaphocephaly (n=155), trigonocephaly (n=50), anterior plagiocephaly (n=28), occipital plagiocephaly (n=1), non-syndromic multi-suture synostosis (n=20), and with diverse craniofacial syndromes (n=32; 11 Crouzon, 11 Apert, 7 Pfeiffer, 2 Saethre-Chotzen, and 2 clover-leaf skull). We used the classification of Whitaker et al. to evaluate the surgical results. Complications of each technique and time of patients' hospitalization were also recorded. The surgeries were classified in 12 different types according to the techniques used. Type I comprised endoscopic assisted osteotomies for sagittal synostosis (42 cases). Type II included sagittal suturectomy and expanding osteotomies (46 cases). Type III encompassed procedures similar to type II but that included frontal dismantling or frontal osteotomies in scaphocephaly (59 cases). Type IV referred to complete cranial vault remodelling (holocranial dismantling) in scaphocephaly (13 cases). Type V belonged to fronto-orbital remodelling without fronto-orbital bandeau in trigonocephaly (50 cases). Type VI included fronto-orbital remodelling without fronto-orbital bandeau in plagiocephaly (14 cases). In Type VII cases of plagiocephaly with frontoorbital remodelling and fronto-orbital bandeau were comprised (14 cases). Type VIII consisted of occipital advancement in posterior plagiocephaly (1 case). Type IX included standard bilateral fronto-orbital advancement with expanding osteotomies (30 cases). Type X was used in multi-suture craniosynostosis (15 cases) and consisted of holocranial dismantling (complete cranial vault remodelling). Type XI included occipital and suboccipital craniectomies in multiple suture craniosynostosis (10 cases) and Type XII instances of fronto-orbital distraction (26 cases).Results. The mortality rate of the series was 2 out of 283 cases (0.7%). These 2 patients died one year after surgery. All complications were resolved without permanent deficit. Mean age at surgery was 6.75 months. According to Whitaker et al's classification, 191 patients were classified into Category I (67.49%), 51 into Category II (18.02%), 30 into Category III (10.6%) and 14 into Category IV (4.90%). Regarding to craniofacial conformation, 85.5 % of patients were considered as a good result and 15.5% of patients as a poor result. Of the patients with poor results, 6.36% were craniofacial syndromes, 2.12% had anterior plagiocephaly and 1.76% belonged to non-syndromic craniosynostosis.The most frequent complication was postoperative hyperthermia of undetermined origin (13.43% of the cases), followed by infection (7.5%), subcutaneous haematoma (5.3%), dural tears (5%), and CSF leakage (2.5%). The number of complications was higher in the group of re-operated patients (12.8% of all). In this subset of reoperations, i...

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Section: Resultsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Surgical treatment of isolated and syndromic craniosynostosis. Results and complications in 283 consecutive cases

et al. 2008

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“…Hansen et al 11 compared the outcomes achieved with 3 different surgical techniques in the management of unicoronal plagiocephaly repair. Their report suggested that only surgical techniques that included the osteotomy of the nasal root significantly improved the nasal canthal associated with the C-shaped deformity of the face.…”

Section: 31mentioning

confidence: 99%

“…3 Two-dimensional photography has been widely used and validated to evaluate the characteristics of craniofacial malformations and to assess the effect of therapeutic surgical procedures in the correction of such conditions. 1,3,10,11,22,32 Three-dimensional photography is a novel technology that allows us to capture a patient's superficial craniofacial anatomy in 3 dimensions. 14,19 This revolutionary imaging technology has the potential of quantifying volumetric changes of the facial soft tissues 6,16,19 as well as cranial vault volume.…”

Section: 31mentioning

confidence: 99%

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Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique

Mesa¹,

Fang²,

Muraszko

et al. 2011

FOC

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Object 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. Methods 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. Results 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). Conclusions 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.

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Unilateral Coronal Craniosynostosis

Massimi¹,

Rocco²

2017

Textbook of Pediatric Neurosurgery

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Synostotic Frontal Plagiocephaly: Anthropometric Comparison of Three Techniques for Surgical Correction

Cited by 69 publications

References 22 publications

Surgical treatment of isolated and syndromic craniosynostosis. Results and complications in 283 consecutive cases

Surgical treatment of isolated and syndromic craniosynostosis. Results and complications in 283 consecutive cases

Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique

Unilateral Coronal Craniosynostosis

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