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.