CLINICAL PRESENTATION AND MANAGEMENT OF 100 INFANTS WITH OCCIPITAL PLAGIOCEPHALY

One hundred consecutive infants who presented with occipital plagiocep haly over 15 years were analyzed retrospectively to determine results of both surgical and nonsurgical management. Eighteen infants who show ed obvious progression of their deformity or radiological signs of fus ion of the lambdoid suture had surgical resection of one or both lambd oid sutures and the remaining 82 infants were treated nonsurgically wi th physical therapy and advice on sleeping position. Of the 18 surgica l cases 9 were found at operation to have true lambdoid synostosis, 7 had marked internal ridging of the lambdoid suture and 2 had an open s uture. After a mean follow-up period of 6 months all parents of the 82 children treated nonsurgically were satisfied with their child's cosm etic appearance: 63% showed improvement in their plagiocephaly and 27% stabilized. There were no surgical complications in the 18 operative cases, all of whom had a good cosmetic result. From these results we c onclude that the majority of infants referred to neurosurgeons with oc cipital plagiocephaly can be successfully managed nonsurgically. A sma ll proportion of cases (18% with radiological signs of fusion or prono unced ridging of the suture) appeared to benefit from surgery. The cli nical, radiological and pathological differentiating features of the s urgical and nonsurgical cases are discussed.