Craniofacial malformation treatment: craniosynostosis and positional plagiocephaly

A fter the publication of the modern Virchow's suture fusion hypothesis regarding craniosy- nostosis, various types of linear craniotomy have been developed. However, after the Moss's functional matrix hypothesis became known, extensive cranial remodeling surgical procedures have emerged. However, a recent view that the cause of craniosynostosis may be due to gene mutation has led to a tendency toward treating craniosynostosis with minimally invasive surgery including endoscopic surgery and distraction procedures that utilize springs or distractors. As nonsyndromic craniosynostoses are accompanied by unilateral coronal or lambdoid craniosynostosis, and syndromic craniosynostoses are accompanied by facial anomalies, it is presumed that cranial anomalies are accompanied by facial anomalies. However, the "back to sleep" campaign that was initiated in the 1990's in order to prevent infantile death syndrome led to research in the dramatic increase in the incidence of craniofacial anomalies, which resulted in the establishment of the positional plagiocephaly concept, which has also been ascertained in animal experiments. Despite these advances, the basic problem of whether craniosynostosis is simply a cosmetic anomaly or whether it is a neurological disease that is accompanied by complications such as increased intracranial pressure has not been resolved. The consequent confusion has prevented establishment of the optimal timing for surgery and the type of surgical procedure. The authors of this study review the history of craniosynostosis treatment and attempt to clarify the situation pertaining to the surgical treatment concepts and limitations.