Objective: Nonsyndromic unilateral lambdoid craniosynostosis (ULC) produces compensatory vault and skull base deformities, including contralateral parietal protrusion and ipsilateral mastoid bulging. Torticollis may manifest as a secondary clinical sequela of this deformity. However, it has received limited attention, and the corrective effects of surgical interventions remain poorly evaluated. This study, therefore, aims to compare outcomes between endoscopic suturectomy (ES) and distraction osteogenesis (DO). Methods: A retrospective review was conducted on 14 patients with nonsyndromic ULC who were treated with surgical correction between 1999 and 2024. Seven patients underwent ES and 7 underwent DO, including trans-sutural distraction and distraction with contralateral contraction. Preoperative and postoperative assessments included cranial index, cranial vault asymmetry index (CVAI), and a novel temporal-parietal asymmetry index (TPAI) developed to assess coronal plane asymmetry and tilted angulation. These parameters were compared between the 2 surgical groups. Results: Secondary torticollis was present in 85.7% of patients preoperatively. Both ES and DO ameliorated axial plane asymmetry (CVAI); however, DO demonstrated greater correction of coronal plane asymmetry (TPAI, P =0.003). Radiographically defined torticollis improved more frequently in the DO group. Linear mixed-effects modeling demonstrated significant time-dependent improvement in both groups, with earlier correction after DO and more gradual remodeling following ES. Conclusions: Secondary torticollis was relatively common among patients with ULC. Differences in the degree and timing of correction were observed between surgical approaches, with DO demonstrating earlier correction and supporting a potential role in selected cases. Surgical planning should be tailored to patient age and severity of cranial deformation.
Byeon et al. (Wed,) studied this question.