Photographic assessment of head shape following sagittal synostosis surgery

A photographic assessment of the head shape of infants who had undergone su rgical correction of sagittal synostosis was performed to determine (a) whe ther this subset could be delineated from an age-matched normal subpopulati on and (b) whether two operative procedures differed in achieving normaliza tion of head shape. This retrospective study included 8 patients who underw ent extended strip craniectomy, 12 patients who underwent subtotal calvarec tomy and cranial vault remodeling, and 12 age-matched subjects with no calv arial abnormality, for a total of 32 subjects. Criteria for inclusion in th is study included surgery for sagittal synostosis within the fil st year of life and postoperative photographs at ages 4 to 8 years (mean, 4.5 years). Each set of images (frontal and lateral profile) were ranked from most to least normal by five lav observers and four professional observers. The ran kings were analyzed with statistics designed fur ordinal data. Differences in ranking between treatment groups were examined with Kruskal-Wallis rank sums tests. Mean ranks were calculated for lay and professional observers i n an attempt to produce simpler and more generalizable results; these: mean s were also analyzed using statistics designed for ordinal data. There was no statistical difference in the ranks of infants who had undergone a surgi cal correction and the normal subpopulation. In the mean rankings of the la y observers, the normal groups had the highest score mean (15.6), the group with extended strip craniectomy was second (16.0), and the subtotal calvar ectomy with calvarial remodeling group was last (17.8) (p = 0.84). In the m ean rankings of the professional observers, the normal groups again had the highest score mean (15.8), the subtotal calvarectomy group was second (15. 9), and the extended craniectomy group was last (18.6) (p = 0.77). These re sults suggest that children who have undergone correction of sagittal synos tosis in infancy are indistinguishable fr-um their peers, on the basis of f ully haired head shape on frontal and lateral photographs, when they begin primary school, irrespective of the type of calvarial surgery.