Premature fusion of one of the coronal sutures results in an asymmetric forehead and brow. On the affected side the forehead is flattened and recessed with the brow and supraorbital rim both elevated and recessed. The contralateral forehead may exhibit compensatory bulging or bossing. This ultimately results in a very asymmetric malformation called plagiocephaly. Technically, plagiocephaly refers to any type of asymmetric skull deformity. However, many authors have used this synonymously with unilateral coronal synostosis.
The incidence of unilateral coronal synostosis in most series of craniosynostosis is between 10-20%. If untreated, this type of synostosis may result in a severe deformity of the forehead, orbit, and nose that persists or worsens with growth. We feel the best treatment for plagiocephaly should involve a bilateral approach with remodeling of the entire forehead and brow between the ages of 9-12 months. Our current surgical treatment consists of extended bicoronal craniectomies with bilateral frontal bone reconstruction. The supraorbital bar is completely removed, reshaped, and straightened. The supraorbital bar is advanced and lowered as necessary on the affected side and fixed in position to the face. The reconstructed forehead is then secured to the supraorbital bar. We feel that the bilateral approach obtains a more symmetric forehead and brow than the unilateral approach.