Referral pattern and surgical outcome of sagittal synostosis

Abstract

Sagittal synostosis (SS) is the commonest form of craniosynostosis, and in the Birmingham Craniofacial Unit has been preferably managed by strip craniectomy when the baby is under 6 months of age or calvarial remodelling when over 6 months old. The unit uses cephalic index (CI) as an objective measure of head shape. This retrospective study analysed referral patterns and the correlation between age at operation and CI. Patients' unit notes and images of 47 patients referred for SS between July 1999 and December 2003 were reviewed. Thirty-three non-syndromic SS patients were studied and demographics, referral information and preoperative and postoperative CI measurements were recorded. Paediatricians referred 91% (mean age 15 months) of cases and general practitioners 9% (all beyond 6 months). There was a significant difference between pre- and postoperative CI for patients operated at less than 12 months (P=0.02). No difference was demonstrated for patients operated at greater than 12 months. Early surgery for SS was associated with a better aesthetic result in this series, although CI may be a crude form of head shape analysis. Later referral was associated with a more complex referral pathway. A fast track system for general practitioners and paediatricians to aid early referrals may improve surgical outcome.