Anterior Craniofacial Changes Following Occipital Switch Cranioplasty in Unilateral Lambdoid Craniosynostosis.

Abstract

ObjectiveAnterior craniofacial changes in unilateral lambdoid craniosynostosis include forehead bossing, increased orbital heights, and asymmetry of the midface and mandible, creating a facial twist. The purpose of this study is to comprehensively analyze the post-operative anterior craniofacial changes in patients with unilateral lambdoid craniosynostosis following occipital switch cranioplasty.DesignRetrospective review of three-dimensional images collected pre-operatively and post-operatively around 2 years.SettingTertiary care pediatric institution.ParticipantsEighteen patients with unilateral lambdoid craniosynostosis.InterventionsCranial vault remodeling with occipital switch cranioplasty.Main Outcome MeasuresFrontal, occipital, height, midface, ear, and orbital asymmetry. Nasal and chin deviation.ResultsFrontal and occipital asymmetry significantly improved post-operatively (P = .03; P < .01). Cranial height asymmetry and midface projection asymmetry did not significantly improve (P = .24; P = .59). The nasal deviation was, on average, 3.58 ± 1.69° prior to surgery and significantly improved with a residual deviation of 2.18 ± 1.35° (P = .01). The chin deviation significantly improved post-operatively from an average of 2.21 ± 1.52° to a residual deviation of 1.07 ± 1.12° (P = .04). Ear asymmetry, orbital width, and orbital height asymmetry did not significantly change with surgery.ConclusionsTwo years after occipital switch cranioplasty, patients with unilateral lambdoid craniosynostosis had significant improvements in frontal asymmetry, nasal deviation, and chin deviation. However, nasal and chin deviation remained residually asymmetric. Midface projection contralateral deficiency did not significantly change post-operatively over the study period. The release of the affected suture with occipital switch cranioplasty allowed for remodeling and growth to improve anterior craniofacial symmetry.