Cranial remolding orthosis for postoperative management of bilateral lambdoid and sagittal synostosis: A case report

Abstract

Case description: This is a report of a 2.5-month-old infant with bilateral lambdoid and sagittal synostosis who underwent minimally invasive suturectomy followed by cranial remolding orthosis (CRO).

Objectives: To evaluate the result of minimally invasive suturectomy followed by CRO treatment in an infant with bilateral lambdoid and sagittal synostosis.

Study design: This is a case report.

Treatment: We fabricated the orthosis based on a computer-aided design and with computer-aided manufacturing technology. Cranial remolding orthosis compliance was measured subjectively. The child's parents were asked to complete a survey using visual analog scales to assess their satisfaction of their child's head appearance, problems with donning/doffing the orthosis, and feedback received from other people.

Outcomes: At the time of fitting, the posterior skull hemisphere volume was 389.4 cm3. The values of cephalic index and cranial vault asymmetry index (CVAI) were 81% and 5%, respectively. After 6 months of CRO treatment, the cephalic index and CVAI were 83% and 1.5%, respectively. Moreover, the posterior skull hemisphere volume was 589.2 cm3. Average compliance with CRO wear was 88%. According to the parental questionnaire results, pressure sores occurred 0% of the time, displacement occurred 15% of the time, contact dermatitis occurred 10% of the time, problems with donning/doffing of the orthosis occurred 27% of the time, difficulties in breastfeeding occurred 30% of the time, negative feedback from other people upset them 55% of the time, and they were 100% satisfied with treatment.

Conclusions: After 6 months of using CRO, the CVAI and skull volume improved and reached their normal proportions. Our results may help ongoing research and clinical care regarding the role of postoperative CRO treatment in patients with complex synostosis.