Total Craniofacial Correction of Plagiocephaly using Intracranial Remodeling Including Occipital Area

ABSTRACT

Plagiocephaly is a premature unilateral coronal craniosynostosis consisting of flattening of the involved frontal region and low-set orbit in affected side and compensatory occipital bulging in contralateral side with resultant facial asymmetry. The authors experienced a 20-year-old male having frontal and posterior palgiocephaly with asymmetric mid-facial appearance in left side who had undergone the strip craniectomy of the coronal suture when he was 100 days old. We performed total intracranial total calvarial remodeling including occipital region followed by two-jaw operation seven months later. Cranial vault was cut into three transverse bone flaps; anterior bi-frontal bone flap, posterior bi-fronto-parietal bone flap, and bi-parieto-occipital bone flap. Unilateral supra-orbital bar advancement with tongue-in-groove arrangement was performed. To restore contour of occipital region, the transposition cranioplasty was done after mid-sagittal osteotomy of posterior bone flap. Seven months later, Le Fort I osteotomy and BSSRO was performed to correct jaw asymmetry and cross-bite. We believe that total correction of orbito-fronto-occipital vault including jaw surgery in plagiocephaly is mandatory for more excellent aesthetic result and effectiveness.