Occipitofrontal Switching for Simultaneous Correction of Synostotic Frontal and Occipital Plagiocephaly: A Novel Surgical Technique

Abstract

Plagiocephaly has traditionally been corrected by unilateral or bilateral frontal bone advancement or rotation using bone-molding forceps and distraction devices. Complete symmetrical correction of deformed frontal bones is considered almost impossible because the curvature of each frontal bone varies. We evaluated the feasibility of measuring the optimal curvature of frontal and occipital bones using a plaster skull model and applying these measurements to ''switch'' them for simultaneous correction of frontal and occipital plagiocephaly. A 2-year-old girl suffering from unifrontal flattening visited our clinic. Unilateral coronal synostosis was observed. The 3-D rapid prototype model and skull replica method using thin paper clay were used for preplanned virtual surgery. The triangular bone was harvested from the contralateral bulging side of the occipital bone (''occipitofrontal switching'') for the best optimal curvature in the affected frontal bone. Another triangular bone was harvested from the ipsilateral flattened side of the frontal bone, and bones were switched with each other. Further bending of the frontal or occipital segment was not necessary for optimal curvature. Symmetrical correction was made by switching the triangular bone of the frontal area with that of the contralateral occipital area. Revision has not been necessary, and infection was not observed at 1-year follow-up. Our novel technique of preplanning surgery using a 3-D plaster model for simultaneous correction of frontal and occipital plagiocephaly is effective and time-saving.

Occipitofrontal switch for correction of anterior plagiocephaly planned through virtual mock surgery

“…[ 4 ] Lannelongue and Lane defined the first technique for correction of plagiocephaly in the later part of the 18 th century in the form of strip craniectomy. [ 6 , 7 ] These techniques allowed cranial decompression but they did not correct the cosmetic deformity. In 1967 Tessier presented his landmark paper regarding cranial vault remodeling which is still the gold standard.…”