Comparative Morphologic Outcomes of Occipital Switch Cranioplasty With or Without Occipital Neo-Bandeau in Unilateral Lambdoid Synostosis

ObjectiveUnilateral lambdoid synostosis (ULS) is characterized by posterior plagiocephaly with a complex cranial and facial asymmetry. The occipital switch (OS) technique is commonly used to correct the posterior vault deformity, while the occipital neo-bandeau (ON) has been proposed as an adjunct to improve cranial vault proportions. The purpose of this study was to compare post-operative differences in craniofacial morphology between OS and OS + ON in ULS.DesignA retrospective review of three-dimensional images obtained pre-operatively and at 1-year post-operatively.SettingTertiary care pediatric institution.Patients, ParticipantsTwenty-four patients with ULS.InterventionsThirteen patients received OS, and 11 received OS + ON.Main Outcome Measure(s)Craniometric measurements included anterior, posterior, and height asymmetry ratios; turricephaly index; and nasal and chin deviation.ResultsBoth cohorts demonstrated significant post-operative improvements in anterior, posterior, and height asymmetry, as well as nasal and chin deviation (P < 0.05). The OS + ON cohort demonstrated a significant post-operative increase in the turricephaly index (P = 0.039), which was also significantly greater than in the OS-alone group in the intergroup comparison (P = 0.037).ConclusionsOS with or without ON results in significant improvements in the posterior cranial vault and facial symmetry in patients with ULS. The addition of ON resulted in a significantly greater increase in cranial height, suggesting a role in patients with vertical deficiency.