Definitive reconstruction of frontal asymmetry in an adolescent with anterior plagiocephaly due to unilateral coronal craniosynostosis using a hybrid osteo-titanium technology based on an individualized approach: A case report

Background: Unilateral coronal craniosynostosis causes three-dimensional craniofacial asymmetry. Although correction is usually performed during infancy, some patients present in adolescence with an untreated or persistent deformity. We describe an individualized hybrid reconstruction combining a patient-specific titanium implant with autologous bone. Case Description: A 15-year-old girl with untreated left unilateral coronal craniosynostosis presented with marked frontal and fronto-orbital asymmetry. Three-dimensional computed tomography demonstrated left frontal retrusion, orbital asymmetry, reduced orbital height, and obliteration of the left coronal suture. Computed tomography-based mirror imaging and computer-aided design were used to create a patient-specific titanium implant containing three compartments for autologous bone. Reconstruction was performed through an asymmetric bicoronal approach. An atypical anterior course of the superior sagittal sinus was identified during bone-flap elevation. Harvested cranial bone was reshaped and incorporated into the titanium framework. Complete filling of all compartments was not possible because the bone required fragmentation to reproduce the intended frontal contour. Postoperative imaging demonstrated improved frontal and fronto-orbital symmetry with stable implant positioning. At 16 months, the reconstructed contour remained preserved, without implant displacement, loosening, fracture, infection, substantial bone resorption, or revision surgery. Progressive mineralized continuity was observed between the autologous bone and adjacent native skull. Conclusion: Patient-specific hybrid osteo-titanium reconstruction was technically feasible and provided stable intermediate-term correction of established frontal asymmetry. Further cases, quantitative assessment, and longer follow-up are required to determine its reproducibility and long-term value.