Treatment of sagittal synostosis: subtotal cranial vault remodelling with right-angled Z-osteotomies.
BACKGROUND
Sagittal synostosis is the most common type of non-syndromic craniosynostosis with fusion of the sagittal suture. Various techniques have been introduced for the treatment of this irregular calvarial deformity. However, since these methods were not suitable for patients who were aged over 1 year when they were diagnosed with sagittal synostosis, a new approach should be undertaken.


METHODS
Between 2001 and 2005, five patients who were diagnosed with sagittal synostosis, after the age of 1 year, were treated with subtotal cranial vault remodelling. The procedure consisted of right-angled Z-osteotomies in the frontal and parieto-occipital bones, a shortening of the sagittal strut, and barrel-stave osteotomies in the temporal bone. They were undertaken to expand bitemporal diameter and to shorten anteroposterior diameter.


RESULTS
Cranial index increased from 68.2 to 77.8 immediately after surgery and to 78.4 post-surgery 36 months. Cranial morphologies were satisfactory during follow-up. The main advantage of the procedure is the easy control of fixation angle according to the surgeon's preference. There were no major complications including infections or relapses.


CONCLUSIONS
The treatment goal of sagittal synostosis is to eliminate factors that may impede brain development by assuring an adequate cranial cavity and to maintain an aesthetically acceptable cranial morphology. We obtained functionally and aesthetically favourable results by right-angled Z-osteotomies. Further, our one-staged procedure is safe, especially in patients over the age of 1 year.
Moon
Suk Ho
SH
Department of Plastic and Reconstructive Surgery, The Catholic University of Korea-College of Medicine, St. Mary's Hospital, 62 Yeouido-Dong, Yeoungdeungpo-Gu, Seoul 150-713, Republic of Korea.
Paik
Hye Won
HW
Byeon
Jun Hee
JH
D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010027:Osteotomy / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012886:Skull / Q000002:abnormalities* / Q000601:surgery; D013580:Synostosis / Q000601:surgery*; D016896:Treatment Outcome