LAMBDOID STENOSIS (POSTERIOR PLAGIOCEPHALY) AND CRANIOFACIAL ASYMMETRY - LONG-TERM OUTCOMES

We recently reviewed our series of craniofacial cases involving lambdo id stenosis (posterior plagiocephaly) and positional deformation. We n ow have 22 cases (who underwent surgery) with greater than 1 year foll ow up (range 1-7 years). We were impressed by the potential severity o f the craniofacial deformity that can occur in what is often considere d a positional deformation caused either by intrauterine conditions or by postnatal positioning. To decide which children were candidates fo r craniofacial reconstruction, we reviewed our cases and determined wh at we considered were appropriate criteria for craniofacial surgery. A mong the 22 patients selected for surgery, 16 patients had changes in facial characteristics secondary to skull base and petrous ridge defor mation, which often led to mandibular malalignment. In addition, 11 ch ildren were found to have developed scoliosis of the face, similar to that seen in anterior plagiocephaly. The long-term severity of these s elected craniofacial deformities may be markedly reduced if these chil dren are operated on early with craniofacial reconstruction techniques . The removal of the lambdoid sutures, which appear to apply a twistin g or torque effect on the facial structures and skull base, assisted i n the children's further normal cranial development. In the children t hat were operated on before 1 year of age, most of the facial asymmetr y was corrected. In addition, we observed that several of the children showed correction of the malignment of the ears, a common finding in these cases, Three-dimensional reconstructions have been extremely hel pful in documenting the abnormalities of the skull base and sutural pa tterns and in planning the surgical approaches. All the patients had e ither a Marchac transposition or a bandeau/forehead type reconstructio n. There were no long-term complications, and the esthetic results wer e considered good to excellent.