ASTERION REGION SYNOSTOSIS

Posterior plagiocephaly historically has been associated with synostos is of the lambdoid suture. The incidence, diagnosis, and modes of trea tment for stenosis of the lambdoid suture remain controversial. Common ly, the lambdoid suture is found to be open both on radiographic exami nation and at the time of surgery. The study reports on nine patients who presented with unilateral posterior plagiocephaly and who were fou nd to have open lambdoid sutures, but a stenosed region of the asterio n. The area of involvement included the distal-most lambdoid suture, t he parietomastoid, occipitomastoid, and proximal squamosal sutures. Po sitional molding or torticollis was ruled out in all patients. All the patients showed progressive involvement of the skull base, including anterior shifts of the ipsilateral ear, compensatory ipsilateral front al bossing and malar protrusion. Stenosis of the asterion was diagnose d with three-dimensional computed tomography scans, corroborated at th e time of surgery and confirmed histologically. Surgical correction in volved resection of the affected asterion and reconstruction using a b andeau-technique, barrel staves of the occipital bone and bone graft t ransposition. This approach provided excellent esthetic results in all patients.