Comparative Analysis of Surgical Techniques for the Treatment of Scaphocephaly: Aesthetic Outcomes

Scaphocephaly is the most common form of non-syndromic craniosynostosis and is primarily managed through surgical cranial vault remodeling aimed at correcting cranial deformity and optimizing aesthetic outcomes. Although more extensive surgical techniques may theoretically provide superior cranial reshaping, variations in operative strategy, particularly regarding preservation of the cranial sutures, may significantly influence postoperative cranial contour and caregiver satisfaction. This study aimed to compare parent-reported aesthetic outcomes following surgical correction of non-syndromic scaphocephaly using two open cranial vault remodeling techniques: the H-Renier technique with preservation of the coronal and lambdoid sutures and an expanded technique involving coronal and lambdoid suturectomy. A retrospective cohort study was conducted including pediatric patients who underwent open surgical correction for scaphocephaly between January 2018 and December 2022. Children aged between 6 months and 1 year at the time of surgery were included, with a minimum postoperative follow-up of 24 months. A total of 30 patients were initially recruited; however, aesthetic outcome assessments could not be obtained for 8 patients, resulting in 22 patients included in the final analysis. Patients were treated either with cranial suture preservation or with an expanded technique without suture preservation. Aesthetic outcomes were assessed exclusively through parent-reported evaluations using a structured 10-item questionnaire incorporating the Whitaker classification. The study protocol was approved by the local ethics committee. Parent-reported aesthetic outcomes were satisfactory in both groups, although distinct patterns were observed. Patients treated with suture preservation demonstrated lower rates of cranial asymmetry, absence of prominent bony ridging, and fewer residual cranial contour irregularities, while facial asymmetry was uncommon in both groups. According to the Whitaker classification, more favorable grades were observed in the suture preservation group, whereas patients treated without suture preservation were predominantly classified as grade II. Scar-related outcomes and alopecia were observed in both groups. Despite the assumption that a more aggressive surgical approach might yield superior aesthetic results, surgical correction of scaphocephaly using the H-Renier suture preservation technique achieved comparable, and in several aspects more favorable, parent-reported aesthetic outcomes than the expanded technique. Further prospective studies with larger cohorts, objective cranial measurements, and longer follow-up are warranted to validate these finding