A functional aesthetic approach to correcting the sequelae of sagittal synostosis

Sagittal synostosis is the most commonly treated form of craniosynostosis exhibiting an incidence of 1:5000 births.(1) Early closure of the sagittal suture is the cause of the classic phenotypic presentation of an elongated head, which is characterized by a narrow and low occiput, a saddle-shaped parietal region, and noticeable frontal bossing. Early surgical intervention is the treatment of choice and surgical options range from simple suture excision to total cranial vault remodeling. Noting that a significant proportion of patients present with limited frontal bossing and asymmetry that is more pronounced in the posterior cranium, the author developed the functional aesthetic approach to reconstruction. This operative technique addresses the changes noted in the posterior two-thirds of the cranial vault, completely correcting the sequelae associated with early closure of the sagittal suture. As an added advantage, the reconstructive paradigm is designed to create a dynamic temporal-occipital component that will activate when a child rests in the supine position. This enhances widening of the posterior cranium thus improving long-term results.