Twenty-Year Review of a Single Surgeon’s Experience with Lambdoidal Synostosis: Surgical Technique with Clinical Review
Charles Rodriguez-Feo, B.S., J. Roberto Ramirez-Gavidia, M.D., Marcia Spear, DNP, Kevin Kelly, M.D., D.D.S.
Vanderbilt University Medical Center, Nashville, TN, USA.
Purpose: Many surgical techniques for lambdoidal synostosis have been described, but there remains no clear best practice when it comes to surgical management. Current methods range from complete posterior calvarial reconstruction to distraction techniques.
Methods: A retrospective review was performed on one surgeon’s experience with craniosynostosis between the years of 1994 and 2014. Out of six hundred and sixty-four cases of craniosynostosis, twenty-two primarily involved the lambdoidal suture, a rate of 3.3%. Twenty-one were repaired using a novel “tongue and groove” technique.
Results: Of the twenty-two patients, nineteen were unilateral and three were bilateral. Male-to-female ratio was found to be 3:1. The average age of first craniofacial physician encounter was thirty-four weeks (8.5 months) Average age at time of surgery was forty-three weeks (10.75 months). Of the twenty-two patients, twenty-one had the unilateral tongue and groove technique described in this paper. The average surgical time for just the posterior calvarial reconstruction was 142 minutes with an average blood loss of 178 ml with a 95% blood transfusion rate. Complications included one patient who experienced re-fusion of his lambdoidal suture and fusion of his sagittal suture, another who returned for redo-anterior calvarial reconstruction, and four who returned for bone graft coverage of full-thickness calvarial defects due to a lack of complete reossification.
Conclusions: This surgical technique has been used for over twenty years with good aesthetic results and immediate stabilization combined with preservation of the increased skull volume. This technique provides a reproducible and reliable method of correcting lambdoidal synostosis.
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