The surgical treatment of plagiocephaly

Abstract

AIm: Anterior plagiocephaly usually occurs with premature synostosis of the ipsilateral half of the coronal suture. The forehead is flattened on the affected side, with a backward and upward displacement of the affected orbit. The bulging of the calvaria may occur in the contralateral parietal area. mAterIAl and methOds:This article presents the surgical techniques used over 7 years to treat plagiocephalic children. Eleven patients with unilateral coronal synostosis treated during 2003-2010 were analyzed retrospectively. The study included reviews of pre and postoperative computed tomography scans, operative techniques, clinical outcomes and complications. Unilateral orbital advancement with "tongue in groove" was performed in 5, and bilateral orbital advancement in 6 cases. Pre and postoperative anthropometric measurements were used to document the amount of advancement of the elevated and recessed orbita, and the amount of withdrawal of the contralateral side. results:The mean age of the patients at time of surgery was 11 months. The preoperative values of the orbital height and retrusion were 0.68 cm and 1.87 cm, respectively. They were recorded as -0.1cm and 0,63 cm, postoperatively. Mean follow-up was 36 months, neither neurological sequelae nor other significant complications were encountered. COnClusIOn:The surgical corrections have resulted in significant improvements in skull shape and high patient/parent satisfaction.KeywOrds: Plagiocephaly, Unilateral, Coronal synostosis, Fronto-orbital advancement ÖZ AmAÇ: Anterior plajiosefali genellikle koronal sutürun ipsilateral yarısının erken sinostosisi sonucu oluşur. Etkilenen yöndeki alın bölgesinde düzleşme olurken aynı taraftaki orbita geriye ve yukarıya doğru yer değiştirir. Karşı taraftaki parietal bölgede kabarıklık olabilir. yÖntem ve GereÇ: Bu çalışmada, plajiosefalik çocukların tedavisinde 7 yıldır tarafımızdan yapılan cerrahi teknikler ve sonuçları sunulmaktadır. Retrospektif olarak 2003-2010 yılları arasında tek taraflı koronal synostosisi olan 11 hastaya uygulanan cerrahi tedaviler ve sonuçları incelendi. Bu çalışmada ameliyat öncesi ve sonrası bilgisayarlı tomografileri, ameliyat teknikleri, klinik sonuçları ve komplikasyonları analiz edildi. Beş hastaya unilateral orbital ilerletme, 6 vakaya ise bilateral orbital ilerletme yapıldı. Ameliyat öncesi ve sonrası antropometrik ölçümler yapılarak geride ve yukarıda olan orbitanın ilerletilme miktarı, kontralateral tarafın ise geriye alınma miktarları yani plajiosefalinin düzelme miktarları dokümante edildi.BulGulAr: Ameliyat sırasında hastaların yaş ortalaması 11 aydı. Ameliyat öncesi orbita yüksekliği ve retrüzyon miktarı sırasıyla ortalama 0.68 cm ve 1.87 cm idi, ameliyat sonrası bu değerler ise sırasıyla -0.1 cm ve 0.63 cm bulundu. Hastaların ortalama takip süresi 36 ay olup herhangi bir komplikasyon görülmedi. sOnuÇ: Cerrahi tedavi sonrası kafatasında belirgin düzelme olurken hasta ve ebeveyin memnuniyeti de yüksek olmuştur.

Trigonocephaly: Case Report, Review of Literature and a Technical Note

“…The treatment of trigonocephaly and craniosynostosis remains surgical and is likely to remain so. In general, the two main indications for surgical treatment of any craniosynostosis including trigonocephaly include correction of the skull deformity for aesthetic and psychosocial purposes and ensuring there is adequate space for normal brain growth [8].…”

A novel surgical rotation overlapping craniotomy technique for the management of non-syndromic anterior plagiocephaly

“…Non-syndromic craniosynostosis is an isolated disorder with no genetic syndromes associated with it. Anterior plagiocephaly (AP) is a general term that denotes the unilateral flattening of the cranium's anterior quarter and is caused by unilateral coronal synostosis (UCS) [2]. The most common types of craniosynostosis after sagittal synostosis are UCS and metopic synostosis.…”

“…Premature coronal suture fusion combined with the rapidly expanding infant brain results in the typical AP morphology [5]. UCS produces restriction of regional growth and compensatory expansion of adjacent regions with an evident fronto-orbital dysmorphology [2].…”

“…Different techniques for craniosynostosis have been developed since the 1960s, such as fronto-parietal suturectomy, lateral canthal advancement, and bilateral fronto-orbital advancement (FOA) [2]. Surgical intervention is targeted to correct the asymmetrical forehead and supraorbital region, with bone advancement on the affected side.…”

Surgical Correction of Unicoronal Craniosynostosis with Frontal Bone Symmetrization and Staggered Osteotomies

“…Unicoronal synostosis produces regional growth restriction and compensatory expansion of adjacent regions and obvious fronto-orbital dysmorphology [ 2 ]. Since the 1960s and disclosure of craniofacial surgery by Tessier, different techniques for craniosynostosis have been developed, such as fronto-parietal suturectomy, lateral canthal advancement, and bilateral fronto-orbital advancement [ 2 ]. One of the problems in patients with unicoronal synostosis is frontal bone deficiency in the affected side.…”