Occipital plagiocephaly

The diagnosis of occipital plagiocephaly has remained a complex and controv ersial issue in the field of craniofacial surgery. Over the past 30 years, numerous studies have been published describing the management and treatmen t for 'posterior plagiocephaly', 'plagiocephaly without synostosis', 'defor mational plagiocephaly' and 'occipital plagiocephaly', with surgical 'corre ction' being chosen as the primary modality of treatment irrespective of th e patency status of the lambdoid sutures. Two hundred and four patients with unilateral occipital plagiocephaly have been seen at the Australian Craniofacial Unit over the past 16 years. Each patient was evaluated by a craniofacial surgeon, paediatric neurosurgeon an d paediatric geneticist. All children underwent plain radiographs of the sk ull to define the sutural anatomy. In those patients where the sutural anat omy was equivocal, 2-D and 3-D CT scans were performed. Only two of the 204 patients (similar to 1%) manifested the clinical, radio graphic and pathological features of true unilambdoid synostosis. There was radiographic evidence of sutural fusion on plain films, 2-D and 3-D CT sca ns. Pathology specimens showed bony sutural fusion. Two hundred and two patients presented with unilateral occipital deformitie s and patent sutures on radiography. These patients with occipital plagioce phaly in the absence of true synostosis were initially managed conservative ly (head positioning, and physiotherapy in those patients with torticollis) . Those patients who underwent surgical correction in infancy (21/204) incl uded patients with severe plagiocephaly not responding to conservative ther apy (19/204) and the two patients with true unilambdoid synostosis (2/204). One hundred and ninety-one of the total patients (94%) were noted by their parents to have acceptable improvement in their head shape. Thirteen patien ts were seen within the past year and are too early to assess. Two surgical patients (one fronto-orbital advancement, one occipital craniectomy) and o ne patient followed conservatively were judged by their parents to be witho ut notable improvement. In our series it is apparent that the majority of c ases of occipital plagiocephaly are not secondary to true synostosis and ca n be managed by conservative positional measures. (C) 2000 The British Asso ciation of Plastic Surgeons.