Skeletal and functional craniofacial adaptations in plagiocephaly.

The present report aims to contribute to our understanding of craniofacial development in plagiocephaly. A previously unreported dry skull with plagiocephaly and two clinical cases with unoperated plagiocephaly are presented. The clinical cases were followed longitudinally with roentgencephalometry in lateral, frontal, and axial projections. In addition, in one of the cases, electromyographic analysis of the temporal, masseter, sternomastoid, and trapezius muscles was carried out. The dry skull revealed premature closure of the sphenofrontal suture in addition to the coronal suture. Furthermore, severe asymmetry of the cranial base and mandible was observed. The clinical cases revealed a similar marked asymmetry of the cranial base. Mandibular asymmetry was observed to develop in early infancy secondary and compensatory to the primary asymmetry of the cranial base. The electromyographic examination revealed that the muscles of mastication were less developed on the affected side. Furthermore, the analysis of the muscles of the neck would seem to indicate that the patient compensated for her cranial base asymmetry and lateral deviation of the orbital axis on the affected side by rotating the head to the opposite side to secure binocular vision. Based on these findings, it would seem pertinent to consider early surgical release of the sutures of the calvaria and cranial base in plagiocephaly to prevent asymmetric facial development.