Differential management of scaphocephaly

• Published in: The Laryngoscope 2012-02, Vol.122 (2), p.246-253
• Main Authors: Tatum, Sherard A., Jones, Lamont R., Cho, Minji, Sandu, Ranjit
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; cranial malformation; Craniosynostoses - diagnosis; Craniosynostoses - surgery; craniosynostosis; Craniotomy - methods; Diseases of the osteoarticular system; Female; Follow-Up Studies; Humans; Infant; Length of Stay; Level of Evidence: 4; Male; Malformations and congenital and or hereditary diseases involving bones. Joint deformations; Medical sciences; Otorhinolaryngology. Stomatology; Reconstructive Surgical Procedures - methods; Retrospective Studies; sagittal suture; Scaphocephaly; Severity of Illness Index; Skull - abnormalities; Skull - diagnostic imaging; Skull - surgery; skull deformity; synostosis; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.22463

Objectives/Hypothesis: The objective of this study was to review the outcomes of scaphocephaly management. We hypothesized that differential treatment of scaphocephaly based on age at correction and degree of severity yields consistently satisfying results while reducing the operative morbidity. Study Design: Retrospective patient record review. Methods: Three cranial vault–remodeling procedures with varying levels of aggressiveness (limited‐access, partial, and total cranial‐vault remodeling) were performed on patients with scaphocephaly from 1995 to 2010. More‐aggressive procedures were performed on older patients and patients having more‐severe deformities. Patient records were reviewed for age, weight, blood loss, and length of hospital stay, and cephalic indices (CIs) were calculated from computed tomography scans and clinical photographs. Results: Fifty‐one patients underwent surgery for scaphocephaly during the study period. The average estimated blood volume fraction lost was 0.41. The average length of hospital stay was 4.49 days. Pre‐ and postoperative CIs were calculable for 36 patients. The average preoperative CI was 68.7. The average postoperative CI was 79.3, for an average operative change of 15%. The three procedures had statistically different values for average length of stay. A trend was suggested for estimated blood loss and volume fraction lost. There was no statistically significant difference in CI outcomes. Conclusions: This study supports the concept of a proportionate response in the management of scaphocephaly. Less‐aggressive procedures do not yield less‐desirable results when properly selected to match the clinical situation of the individual patient.