Work

Anterior Craniofacial Changes Following Occipital Switch Cranioplasty in Unilateral Lambdoid Craniosynostosis

Year: 2025

Type: article

Abstract: Objective Anterior 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. Design Retrospective review of three-dimensional images collected pre-operatively and post-operatively around 2 years. Setting Tertiary care pediatric institution. Participants Eighteen patients with unilateral lambdoid craniosynostosis. Interventions Cranial vault remodeling with occipital switch cranioplasty. Main Outcome Measures Frontal, occipital, height, midface, ear, and orbital asymmetry. Nasal and chin deviation. Results Frontal 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. Conclusions Two 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.

Source: The Cleft Palate-Craniofacial Journal

DOI: 10.1177/10556656251326351