Frontal plagiocephaly: synostotic, compensational, or deformational.

Area of Science:

• Pediatric Plastic Surgery
• Craniofacial Surgery
• Developmental Pediatrics

Background:

• Frontal plagiocephaly is a common congenital forehead asymmetry.
• Accurate diagnosis is crucial for appropriate management.
• Distinguishing between synostotic and deformational plagiocephaly impacts treatment strategies.

Purpose of the Study:

• To retrospectively evaluate patients with frontal plagiocephaly.
• To categorize frontal plagiocephaly into synostotic, compensational, and deformational types.
• To identify reliable physical examination findings for differential diagnosis.

Main Methods:

• Retrospective analysis of 60 patients with frontal plagiocephaly.
• Classification into synostotic (N=24), compensational (N=3), and deformational (N=33) groups.
• Detailed physical examination focusing on supraorbital rims, nasal root, ears, malar eminences, chin, palpebral fissures, and facial height.

Main Results:

• Physical examination reliably differentiated synostotic from deformational frontal plagiocephaly.
• Deformational cases showed higher incidence of other deformational anomalies and ipsilateral torticollis (64%).
• Synostotic cases presented with contralateral head tilt (14%) and a higher left-sided involvement (46% vs 73% in deformational).
• Female preponderance observed in both synostotic (79%) and deformational (76%) types.
• Premature pelvic descent may explain left-sided deformational plagiocephaly and torticollis.

Conclusions:

• Physical examination is effective for classifying frontal plagiocephaly.
• Associated anomalies and torticollis patterns differ between synostotic and deformational types.
• Understanding these differences aids in diagnosis and management of pediatric forehead asymmetry.