J Korean Med Assoc.  2012 Sep;55(9):878-886. 10.5124/jkma.2012.55.9.878.

Craniofacial malformation treatment: craniosynostosis and positional plagiocephaly

• Park DH
• Yoon SH

• KMID: 1787251
• DOI: http://doi.org/10.5124/jkma.2012.55.9.878

Abstract

After the publication of the modern Virchow's suture fusion hypothesis regarding craniosynostosis, various types of linear craniotomy have been developed. However, after the Moss's functional matrix hypothesis became known, extensive cranial remodeling surgical procedures have emerged. However, a recent view that the cause of craniosynostosis may be due to gene mutation has led to a tendency toward treating craniosynostosis with minimally invasive surgery including endoscopic surgery and distraction procedures that utilize springs or distractors. As nonsyndromic craniosynostoses are accompanied by unilateral coronal or lambdoid craniosynostosis, and syndromic craniosynostoses are accompanied by facial anomalies, it is presumed that cranial anomalies are accompanied by facial anomalies. However, the "back to sleep" campaign that was initiated in the 1990's in order to prevent infantile death syndrome led to research in the dramatic increase in the incidence of craniofacial anomalies, which resulted in the establishment of the positional plagiocephaly concept, which has also been ascertained in animal experiments. Despite these advances, the basic problem of whether craniosynostosis is simply a cosmetic anomaly or whether it is a neurological disease that is accompanied by complications such as increased intracranial pressure has not been resolved. The consequent confusion has prevented establishment of the optimal timing for surgery and the type of surgical procedure. The authors of this study review the history of craniosynostosis treatment and attempt to clarify the situation pertaining to the surgical treatment concepts and limitations.

Keyword

Craniosynostoses; Nonsynostotic plagiocephaly; Endoscopic craniotomy; Distraction osteogenesis

MeSH Terms

Animal Experimentation
Cosmetics
Craniosynostoses
Craniotomy
Incidence
Intracranial Pressure
Osteogenesis, Distraction
Plagiocephaly, Nonsynostotic
Publications
Sutures
Cosmetics

Figure

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  Figure 1 Comparison of cranial contour of the positional plagiocephaly with that of the left lambdoid synotosis. (A) Posterior cranial contour of the positional plagiocephaly. (B) Posterior cranial contour of the left lambdoid synotosis. (C) Vertex cranial contour of the positional plagiocephaly. (D) Vertex cranial contour of the left lambdoid synotosis (From Park JY, et al. Textbook of pediatric neurosurgery. Seoul: Doctors-Book; 2011, with permission from the Korean Society for Pediatric Neurosurgery) [1].

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  Figure 2 Early surgical methods for the craniosynostosis. (A) A simple linear craniotomy along the fused suture. (B) Insertion of aluminum foil or polyethylene film into the linear suturectomy site. (C) Morcellation procedure modified from linear craniotomy. (D) Circular craniotomy modified from linear craniotomy.

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  Figure 3 Extensive surgical methods for the craniosynostosis. (A) Extended craniectomy procedure without remodeling. (B) Π procedure with extended craniectomy and minimal remodeling. (C,D,E,F,G) Extensive total calvarial craniectomy and remodeling. (H) Barrel stave osteotomy modified from morcellation procedure (From Park JY, et al. Textbook of pediatric neurosurgery. Seoul: Doctors-Book; 2011, with permission from the Korean Society for Pediatric Neurosurgery) [1].

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  Figure 4 Minimal surgical method of distraction osteogenesis with distracters for bicoronal (A), sagittal (B,C,D,E), and lambdoid (F) craniosynostosis (From Park JY, et al. Textbook of pediatric neurosurgery. Seoul: Doctors-Book; 2011, with permission from the Korean Society for Pediatric Neurosurgery) [1].

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  Figure 5 Minimal surgical method of distraction osteogenesis with spring for sagittal craniosynostosis.

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  Figure 6 Minimal surgical method of trans-sutural distraction osteogenesis with distracters for bicoronal (A), sagittal (B), lambdoid (C), and unicoronal (D) craniosynostosis (From Park JY, et al. Textbook of pediatric neurosurgery. Seoul: Doctors-Book; 2011, with permission from the Korean society for pediatric neurosurgery) [1].

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