CONDITIONS TREATED BY OUR CRANIOFACIAL GROUP

Number of patients treated from 1976 to 31rst/12/2004 : 2 592

150 to 200 patients are operated every year by our team 

		Non syndromic craniosynostosis : 1 836	Syndromal craniosynostosis : 413
		• Oxycéphaly : 115 • Trigonocephaly : 350 • Scaphocephaly : 799 • Lambdoïds : 9 • Rares formes : 93 • Positionnel plagiocephaly : 39 • Brachycephaly : 138 • Plagiocephaly : 335	• Apert : 103 • Crouzon : 120 • Saethre-Chotzen : 79 • Pfeiffer : 43 • Frontonasal dysplasia : 30 • Other syndromes :38
		Medial clefts - Hypertelorism : 118	Fibrosis Dysplasia : 45
		Lateral clefts : 34	Orbital neurofibromatosis : 48
		Meningoceles : 35	Craniofacial traumas : 63

Congenital Anomalies
	Craniosynostosis and Faciosynostosis
		Non syndromal	Syndromal
		• Metopic (trigonocephaly) • Sagittal (scaphocephaly) • Coronal unilatral (plagiocephaly) • Coronal bilateral (brachycephaly) • Coronal and sagittal (oxycephaly) • Lamboïd (pachycephaly)	• Crouzon • Apert • Pfeiffer • Saethre-Chotzen • Fronto-nasal Dysplasia • etc...
		Complex Positional deformity (cf end of page)
	Hypertelorism - Facial Clefts
		Midline facial clefts	Lateral facial clefts
		• Without nasal anomalies • With nasal anomalies	• With nasal, eyelid anomalies
	Encephaloceles
		• Fronto-orbito-nasal • Occipital
	Lateral anomalies
		• Treacher-Collins - Franceschetti • Orbital Dystopia
	Growth Anomalies
		• Neurofibromatosis • Fibrous Dysplasia • Dysostosis • Hyperostosis
Trauma and Post-traumatic Sequelae
		• Frontonasal Fractures • Craniofacial Disjunction • Facial Retrusion • Nasal Dislocation • Orbital Dystopia • Enophtalmos

Positional deformities (positional plagiocephalies without craniosynostosis)

In order to diminish the number of sudden death of babies, the pediatricians have recommended, to have them laying on their back. Since then, (1992) there has been  a tremendous increase of the number of posterior cranial deformations. 

The flattening is secondary to a mecanichal force. Usually, there is a flattening of one side of posterior part of the skull, related to the fact that the infant is laying all the time on the same side.

If there is a congenital torticollis, it should be treated by reeducation.

Positional instructions should be given :

• avoiding that the child sleeps on the flattened side
• positioning the child in ventral position when he is awake
• stimulating rotation to the non affected side, by adjusting light, positioning toys and so on

The chances of improvement with these simples manoeuvers are maximum before 6 months and diminish gradually until 18 months. After 18 months, spontaneous improvement cannot be expected any more.

In doubt about the diagnostis, a standard x-ray front and profile of the cranium will show if the lambdoïd suture is normal or absent. If absent –it is rare- a craniofacial surgeon should evaluate the situation.

 Deformities linked to the positional plagiocephaly can be significant, and even sometimes require a surgical correction. It is done only in severe cases since it is a high risk operation.