Modified Technique of Temporal Osteotomy in Fronto-Orbital Advancement in Anterior Plagiocephaly

Nonsyndromic anterior plagiocephaly is one of the most common types of craniosynostosis. In recent years, various surgical techniques have been introduced to correct this deformity, which many surgeons believe have not been associated with adequate clinical and aesthetic results. The aim of the study was to introduce a new surgical technique (modified Z-technique of temporal region osteotomy) and to evaluate the aesthetic and anthropometric outcomes of frontal orbital correction for the management of patients with nonsyndromic anterior plagiocephaly.

In this cohort study, 47 patients with nonsyndromic anterior plagiocephaly who were operated on in 15-Khordad and Mofid Hospital affiliated to Shahid Beheshti University of Medical Sciences during the years 2018 to 2023 with the modified z-technique of temporal region osteotomy, were investigated. Aesthetic outcomes and changes in anthropometric parameters of the skull were evaluated 2 years after surgery. Also, the length of surgery, the mean length of stay in the hospital and ICU, the amount of bleeding and postoperative complications were evaluated. Postoperative recurrence of deformity was evaluated according to the Whitaker classification.

The mean age of the patients was 11.1±4.15 months. Twenty-seven (57.44%) patients were female and 20 patients were male. The mean follow-up period of the patients was 19.3±3.54 months. The mean weight of the patients was 13.12±7.45 kg. The mean length of hospital stay and ICU stay were 5.44±0.50 and 1.78±0.63 days, respectively. A significant positive correlation was observed between the duration of surgery and the duration of stay in ICU ( r =0.23, P =0.023). According to Whitaker's classification, 39 (82.97%) patients were classified in class I, 4 (8.51%) in class II, 2 (4.25%) in class III, and 2 (4.25) in class IV. Aesthetically, the surgical results were excellent (class I Whitaker) in 82.97%. No serious complications such as infection, CSF rhinorrhea, hematoma occurrence, skull defect occurrence, fever, bleeding, and postoperative mortality were reported.

Our study showed that the modified z-technique of temporal region osteotomy was associated with good and excellent aesthetic and clinical results. Bleeding rate, average length of hospital stay, and average length of ICU stay in patients with nonsyndromic anterior plagiocephaly treated with modified Z-technique of temporal region osteotomy were low and comparable with other with other reported series. No cases of serious complication and death were reported during the follow-up period. Nonsyndromic anterior plagiocephaly can be successfully treated with modified Z-technique of temporal region osteotomy with good results and low complication rates.