Cloverleaf skull deformity (Kleeblattschädel-Syndromen, trilobular skulls) results from synostosis of multiple cranial sutures. The number of sutures involved, the pathogenesis of the synostosis, and the associated anomalies and syndromes are variable. All forms of cloverleaf skull are associated with a high morbidity and mortality. Management of surviving infants requires multiple decompressive and reconstructive operative procedures. Maximal advancement of the forehead/brow at the initial surgery is usually not enough to correct the associated proptosis and a second brow advancement must be done. We present a patient with Apert syndrome and cloverleaf skull deformity that required early (1 month old) cranial vault decompression due to severe proptosis and papilledema. Our management included the placement of osteogenesis distracters on the forehead/brow to gain additional advancement and expand the soft tissue.
From the Department of Plastic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN.
Received November 7, 2012, and accepted for publication, after revision, November 18, 2012.
Conflicts of interest and sources of funding: none declared.
Reprints: Annie Harpe, Research Coordinator, Department of Plastic Surgery, University of Tennessee College of Medicine Chattanooga, 979 E. 3rd St, Suite C920, Chattanooga, TN 37403. E-mail: firstname.lastname@example.org.