Chapter
3:
Posterior Plagiocephaly
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Chapter
3: |
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Craniosynostosis
Posterior Plagiocephaly
Craniosynostosis |
There has been a significant increase in the past several years of
infants referred for evaluation of occipital deformities. This increase
in occurrence of posterior skull deformities appears to be related to
the 1992 recommendation for supine sleep positioning by The American
Academy of Pediatrics to avoid Sudden Infant Death Syndrome. Occiput
deformities can be divided into lambdoid synostosis and deformational or
positional plagiocephaly.
The lambdoid suture is a paired structure that transverses in a symmetric fashion across the posterior aspect of the skull. Premature fusion or synostosis of this suture is rare but may be unilateral or bilateral.
Characteristically in unilateral synostosis the posterior skull is flattened on the involved side. Displacement of the ear with compensatory skull changes may be present in severe cases. Bilateral synostosis is characterized by extensive flattening across the posterior skull and increased vertical growth to accommodate brain enlargement. In mild cases the deformity can be covered by hair and surgical repair may not be indicated. When there is significant flattening or asymmetry, we recommend release of the fused sutures and posterior skull remodeling. Surgical treatment consists of extensive posterior skull craniectomies with remodeling of both sides of the occiput and posterior advancement of the affected side. Rigid fixation with microplates is used to hold the reconstructed bones in position and maintain the contour until healing takes place. Occipital plagiocephaly without synostosis must be distinguished from lambdoid synostosis. Most patients referred to our center for posterior skull deformities are deformational or positional plagiocephaly. In these infants, the skull becomes misshaped from repeated pressure on the same position, without the premature fusion of the lambdoid suture. Positional plagiocephaly usually improves without surgery. Once the child's sleep patterns change and he spends more time awake, the brain's normal growth forces help to reshape the posterior skull. Some centers recommend a custom fitted helmet to mold the head back into position over a period of several months. However, in cases where the posterior skull deformity progresses or is severe, we recommend surgical remodeling as described, even though a true synostosis may not be present.
The Tennessee Craniofacial
Center, part of the Erlanger Health System, is located in Chattanooga,
Tennessee. The Center, led Larry A. Sargent, M.D., specializes in the
evaluation and treatment of patients of all ages with craniofacial deformities.
Location:
975 East Third Street. Chattanooga, Tennessee 37403
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