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.