Posterior plagiocephaly: proactive conservative management

The pathology, diagnosis and management of posterior plagiocephaly remains highly controversial. While the rationale for surgical management of true l ambdoid synostosis is undisputed, opinions vary greatly on how to manage se vere, unresolving, non-synostotic cases. We reviewed 39 cases of posterior plagiocephaly, 37 of which were treated conservatively. Of these, 34 patien ts had a significant improvement over the following year with sleep posture modification and/or physiotherapy. While only eight cases returned to comp lete normality, the remainder had deformities that were deemed mild by both mothers and surgeons, and did not merit surgery. Defining recalcitrant cas es remains elusive as standard imaging is often unhelpful. While 3-D CT off ers a much more accurate diagnosis of true lambdoid synostosis with bony un ion and allows objective assessment of the deformity, serial scans involve radiation doses that are difficult to justify. Clinical follow-up is the on ly reliable method at present.