Occipital flattening in the infant skull.

Occipital plagiocephaly caused by lambdoid synostosis is rare. Positional flattening is more common and will most often respond to conservative measures. Surgical correction of a flat occiput is warranted if the deformity is profound. Skull molding devices may be effective for treating mild abnormalities but are ineffective in the more severe cases. An operative procedure is described that uses a microplate-reinforced median bar to provide a rigid scaffold to maintain the occipital correction. Seventy-three consecutive patients were evaluated over a 3-year period for occipital plagiocephaly. Of these individuals, only one had true lambdoid synostosis and six required surgery. There were no operative complications and cranial length was increased from 84 to 94% of age-matched controls after surgery. The need for operative intervention is rare; however, it should be based on the severity of the posterior deformity, especially when accompanied by compensatory frontal bossing, and not on the etiology of the flattening.