Unilateral Coronal Synostosis (Anterior Plagiocephaly)

Posnick, Jeffrey C.

doi:10.1097/00000637-199604000-00021

Cited by 38 publications

(11 citation statements)

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“…Many other variations have been introduced and include threequarter orbital osteotomies with reshaping, and repositioning of the orbital rims and forehead. 26,27 Calvarial remodeling techniques are typically associated with significant blood loss, blood transfusions, postoperative swelling, and pain, as well as prolonged (4-6 day) hospital stays. Overall, the immediate postoperative results are excellent, but close and careful longterm follow-up of these patients indicates progressive changes leading to poor results.…”

Section: Discussionmentioning

confidence: 99%

Early treatment of coronal synostosis with endoscopy-assisted craniectomy and postoperative cranial orthosis therapy: 16-year experience

Jimenez¹,

Barone²

2013

PED

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Object The objective of this study was to present the authors' 16-year experience treating coronal craniosynostosis in infants using endoscopy-assisted techniques and postoperative cranial orthoses. Methods A total of 128 synostosed coronal sutures in 115 patients were treated between 1996 and 2012 by endoscopically resecting a strip of bone containing the stenosed suture via a 2–3 cm incision made at the ipsilateral stephanion. Data were obtained from a prospective database. Following surgery, patients were fitted with custom cranial orthoses to help correct preoperative craniofacial deformities. All patients were followed closely with cranial anthropometric measurements and photographs. Results The estimated mean blood loss was 20 ml (range 5–120 ml) and the estimated mean strip size was 0.6 cm × 10.7 cm. The mean surgical duration was 55 minutes (range 22–150 minutes). One patient underwent an intraoperative blood transfusion and 1 had a postoperative blood transfusion, for a total transfusion rate of 1.7%. Ninety-seven percent of patients were discharged on the first postoperative day. There were no deaths. Vertical dystopia correction of more than 80% from baseline was obtained in almost two-thirds of patients, with 51% achieving 100% correction. Nasal and sagittal craniofacial deviation (vertex-nasion-gnathion) correction greater than 80% was achieved in 80% of patients, with 77% achieving 100% correction. Supraorbital rim advancement of the ipsilateral eye was obtained in 98% of cases, with correction of frontal plagiocephaly the last deformity to achieve correction. Conclusions Early treatment of coronal synostosis with endoscopy-assisted craniectomy and postoperative molding helmets leads to significant correction of craniofacial abnormalities, including vertical dystopia, nasal deviation, sagittal misalignment, and ipsilateral proptosis. This treatment method is associated with minimal trauma, blood loss, and transfusion rates, and typically only requires 1 overnight stay. This surgical approach is safe, effective, and associated with excellent results.

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Section: Discussionmentioning

confidence: 99%

Early treatment of coronal synostosis with endoscopy-assisted craniectomy and postoperative cranial orthosis therapy: 16-year experience

Jimenez¹,

Barone²

2013

PED

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“…[13,18,52,72] Still, accurate methods to document the presenting deformity and postoperative results are limited; thus, guidelines for the evaluation of the results are few. [54,56] Because abnormality at a single suture strongly influences the development of other areas in the craniofacial complex, there is a clinical impression that surgical correction during the neonatal period yields superior results. [6,25,42,43,45,49,51,60,61,72] Wall and colleagues [75] recommend that in the absence of clinical or radiological signs of raised ICP, surgery should be delayed until the patient reaches 12 to 15 months of age.…”

Section: Surgical Interventionmentioning

confidence: 99%

Lambdoid synostosis and occipital plagiocephaly: clinical decision rules for surgical intervention

Carson

James²,

Vanderkolk³

et al. 1997

FOC

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Lambdoid craniosynostosis has been regarded as one of the least common categories of premature fusion of the cranial sutures, yet reports have suggested the incidence may be increasing. To guide treatment decisions, the authors describe a set of rules based on radiographic indicators and clinical assessment in the child. Experience suggests that children can have abnormal-appearing cranial sutures with normal neurological status and normal-appearing sutures with neurological deficits or marked cerebral compression. Early evaluation and follow-up treatment is essential for children with suspected craniosynostosis.

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“…The standardised ''Bilateral fronto-orbital advancement and reshaping'' is the most widely advocated surgical management of Anterior Plagiocephaly, based on the ''tongue in groove'' technique developed by Tessier [1,5,[8][9][10]. Our patient was a one year old female child with unilateral right coronal synostosis.…”

Section: Introductionmentioning

confidence: 99%

A Modified Approach to Surgical Correction of Anterior Plagiocephaly

Jeyaraj

2011

J. Maxillofac. Oral Surg.

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The gold standard for surgical correction of both uni- and bilateral coronal synostosis remains to this day, the "standardised bilateral fronoto-orbital advancement and reshaping" based on the "tongue in groove" technique developed by Tessier. It consists of bilateral frontal craniotomy for suture release and decompression, combined with creation of a "supraorbital bar" as a bilateral orbital complex by osteotomising the orbital roof (anterior cranial base), supraorbital ridge and upper lateral orbital rims bilaterally. This is followed by a bilateral advancement and remodelling of the frontal region as well as the orbital region bilaterally which is then rigidly fixed in position, the supraorbital bar to the face (at the fronto-zygomatic region and the fronto-nasal region) and the reconstructed forehead to the supraorbital bar. In this study, a slightly modified procedure was employed for correction of the right sided unilateral coronal synostosis, using a bifrontal craniotomy combined with unilateral orbital osteotomy (creating a unilateral supraorbital bar/bandeau), followed by radial osteotomies/kerfing, reshaping and advancement of the bifrontal calvarial segment. This was followed by the "tongue in groove" advancement of the right orbital segment (unilaterally). We preferred to spare osteotomising the contralateral (that is, the left) orbital region as it was not involved by compensatory growth deformity, and the frontal bossing/bulging was restricted to the upper forehead region alone. A gratifying aesthetic outcome and perfect symmetry was achieved using this technique. There were also no complications like wound infection or dehiscence, CSF leak, bone loss from resorption, damage to orbital contents or brain, recurrence of the dysmorphology or residual deformities or asymmetrics of the orbital region or forehead. Gratifying cosmetic results were seen using this modified technique and it was found that bilateral frontal reshaping and unilateral orbital advancement together with kerfing the frontal segment followed by fixation using resorbable implants is an effective strategy to not only permit remodelling of the skull and face thus correcting the cosmetic deformity, but also to increase the intracranial volume within the anterior cranial vault, without the need for any graft placement.

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Unilateral Coronal Synostosis (Anterior Plagiocephaly)

Cited by 38 publications

References 0 publications

Early treatment of coronal synostosis with endoscopy-assisted craniectomy and postoperative cranial orthosis therapy: 16-year experience

Early treatment of coronal synostosis with endoscopy-assisted craniectomy and postoperative cranial orthosis therapy: 16-year experience

Lambdoid synostosis and occipital plagiocephaly: clinical decision rules for surgical intervention

A Modified Approach to Surgical Correction of Anterior Plagiocephaly

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