Craniofacial Anomalies, Part 2 - Plastic Surgery Internal

SRPS Volume 10, Number 17, Part 2
Fig 16. Posterior plagiocephaly from positional molding (above) and unilambdoid synostosis (below). Arrows indicate vectors of
compensatory growth. (Reprinted with permission from Huang MHS, Mouradian WE, Cohen SR, Gruss JS: The differential diagnosis of
abnormal head shapes: separating craniosynostosis from positional deformities and normal variants. Cleft Palate Craniofac J 35:204, 1998.)
associated with a syndrome, and the remaining 20%
were associated with multiple suture synostosis. 258
Unicoronal synostosis causes regional growth
restriction and compensatory expansion of the neighboring
tissues, producing overt frontoorbital
dysmorphology. Characteristic deformities ipsilateral
to the synostosis include flattening of the frontal bone
and ipsilateral forehead, ipsilateral elevation-recession
of the supraorbital rim, and narrowing and lateral
deviation of the orbit, deviation of the nasal root
towards the flattened side, and elevation of the ipsilateral
ear. 259 On the contralateral side there is bulging
of the frontal bone. 260,261 An AP radiograph usually
demonstrates the characteristic harlequin eye
deformity. Bruneteau and Mulliken 262 believe that
physical examination focusing on the supraorbital
rims, nasal root, ears, and malar eminences can easily
distinguish between synostotic and deformational
plagiocephaly. This distinction has obvious clinical
implications, as synostotic plagiocephaly is the only
group with strong surgical implications.
Lo and colleagues 263 described the endocranial configuration
in unilateral coronal synostosis as follows:
• constriction of the ipsilateral anterior cranial fossa
• deviation of the anterior fossa midline
• elevation of the ipsilateral floor
• straightening of the lesser sphenoid wing
These features of the cranial base correlate with
the orbital dysmorphology. The authors reviewed
28 patients with unicoronal synostosis and noted more
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