Severe deformational plagiocephaly: long-term results of surgical treatment
Alexandre Marchac1, Eric Arnaud, Federico Di Rocco
1Unité de Chirurgie Crânio-Faciale, Hôpital Necker Enfants Malades, Paris, France.
Insights
Surgical remodeling for deformational plagiocephaly (DP) is effective but carries risks. This procedure is best reserved for severe cases after non-surgical methods fail, performed in specialized centers.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Plastic Surgery
Background:
- Deformational plagiocephaly (DP) can cause permanent skull asymmetry if untreated.
- Nonsurgical treatments are effective for DP in infants under one year old.
- Surgical intervention for DP becomes an option for severe cases after 15 months of age.
Purpose of the Study:
- To analyze surgical morbidities associated with deformational plagiocephaly (DP) correction.
- To evaluate the long-term morphologic outcomes of surgical remodeling in DP patients.
- To compare outcomes between two surgical techniques: switch cranioplasty (A) and monobloc graft (B).
Main Methods:
- Retrospective analysis of a craniofacial database and outcome study.
- 30 patients with occipital DP underwent surgery after 15 months of age.
- Two surgical techniques were employed: switch cranioplasty (A) and monobloc graft (B) since 1995.
Main Results:
- Surgical incidents (dural tears, venous sinus breaches) occurred in 28% (A) and 36% (B) of patients.
- One complication necessitated repeat surgery; no CSF leaks or meningitis were recorded.
- No significant difference in long-term morphologic outcomes between the two surgical groups.
Conclusions:
- Surgical correction of DP is a high-risk procedure.
- Indications for surgery should be limited to very severe cases unresponsive to conservative management.
- DP surgery should be performed in specialized craniofacial centers with multidisciplinary expertise.
Introduction:
Deformational plagiocephaly (DP), a benign infantile condition, is often thought to improve spontaneously but can in fact lead to permanent skull asymmetry if left untreated. Deformational plagiocephaly can be completely corrected by nonsurgical treatments if recognized in the first year of life. Nevertheless, efficacy of these treatments drastically diminishes after 9 months as the calvaria thickens. Beyond 15 months, if the asymmetry is severe, surgical remodeling becomes an option. In this study, we analyzed the surgical morbidities and the morphologic outcome of surgical remodeling in DP.
Methods:
This study was designed as a retrospective analysis of a craniofacial database combined with an outcome study. Between January 1992 and August 2006, 2363 occipital DP cases were treated by repositioning. Thirty patients were operated on, always after the age of 15 months (1.23%). Mean (SD) age at the time of the first clinic was 19.2 (± 5.8) months (range, 11-34 mo). A switch cranioplasty (A) was first used, progressively replaced since 1995 by a large occipital monobloc graft rotated 180 degrees and fixed with tongue-in-groove pillars (B). Morbidities were extracted from the database. Long-term morphologic outcomes were evaluated during a free clinic visit with a 4-point Likert-type outcome scale.
Results:
Mean (SD) age at the time of surgery was 20.2 (± 5.6) months. Incidents (dural tears or venous sinus breaches) occurred in 28% (A) and 36% (B) or patients. One complication required repeat operation (extradural hematoma). No cerebrospinal fluid leaks and/or meningitis were recorded. Mean (SD) hospital stay was 5.3 (± 0.95) days. There was no statistical difference in the long-term morphologic outcome between the 2 groups (median of group A being "good but still visible"; median of group B being "excellent, unnoticeable").
Conclusions:
Surgical correction of DP is a potentially life-threatening procedure, which should be indicated only in very severe cases, after exhaustion of all other nonsurgical methods, in a reference craniofacial center combining pediatric neurosurgery and plastic surgery.
