Surgery for unilateral coronal synostosis (plagiocephaly): unilateral or bilateral correction?

Debate still exists concerning the extent of frontal reconstruction for the correction of plagiocephaly resulting from unilateral coronal synostosis. Between 1982 and 1994, 38 patients with unilateral coronal synostosis have been treated in our department. Initially, a unilateral frontal craniotomy with advancement of the ipsilateral supraorbital bar was used in 13 patients. An unsatisfactory postoperative appearance of the forehead led to modification of the technique using a bilateral frontal bone flap. This allowed simpler and improved forehead reconstruction. The method was used in 22 patients. Three patients with severe deformity had the complete supraorbital bar advanced in one piece and the forehead reconstructed with a bilateral frontal flap. The late results were analyzed using a clinical scoring system to grade residual deformity. The patients in the two main groups had similar characteristics. The mean age at first operation was 30.8 months for the first group and 20.1 months for the second group. Mean length of follow-up was 7.9 years for the first group and 4.6 years for the second group. No significant operative complications were observed. In two patients, one from each group, recurrent deformity developed, requiring further surgery. Analysis of the mean scores obtained at set intervals during the first 4 postoperative years showed that forehead correction with a bilateral frontal bone segment and unilateral supraorbital bar advancement provides better early cosmetic results in the first postoperative year. After that interval, the results of the two techniques are similar, with overall good final cosmetic appearances. The patients in the third group who had the complete supraorbital bar advancement with bilateral frontal bone remodeling had more pronounced deformity initially and had a less satisfactory late result. These findings confirm the clinical impression that bilateral frontal bone remodeling offers a better immediate surgical result from the cosmetic point of view compared with other techniques.