Original ArticlesPublic Perception of a Normal Head Shape in Children With Sagittal CraniosynostosisAl-Shaqsi, Sultan Z. MBChB, PhD*; Rai, Ahsan BS, MSc†; Forrest, Christopher MD, FRCSC†; Phillips, John MD, FRCSC†Author Information *Sultan Z Al-Shaqsi, Plastic and Reconsurtive Surgery, University of Toronto, The Hospital for Sick Children †The Hospital for Sick Children, Toronto, Canada. Address correspondence and reprint requests to Sultan Z. Al-Shaqsi, MBChB, PhD, Plastic and Reconsurtive Surgery, University of Toronto, The Hospital for Sick Children, 555 University Avenue, ON, Canada M5G 1X8; E-mail: firstname.lastname@example.org Received 3 September, 2019 Accepted 28 November, 2019 The authors report no conflicts of interest. Journal of Craniofacial Surgery: June 2020 - Volume 31 - Issue 4 - p 940-944 doi: 10.1097/SCS.0000000000006260 Buy Metrics Abstract A question that remains unanswered is at what level of surgical correction does the public perceive a head shape to be “normal” or “acceptable?” For most cases of non-syndromic asymptomatic craniosynostosis, the parents desire for surgical correction is to improve the cosmetic appearance of head shape. At the time of this writing, the intraoperative surgeons’ perspective of what constitutes an acceptable head shape is the target for surgical correction. In introducing an improved objectively cosmetic goal, an appropriate outcome measure would be to assess what the general public considers a normal or acceptable head shape in children with craniosynostosis. Method: Twenty-two unique images were presented via an online crowdsourcing survey of a severe case of non-syndromic sagittal craniosynosis gradually corrected to an age and gender matched normalized head shape. Participants were recruited via the Sick Kids Twitter account. Participants were invited to rate the head shapes as “normal” or “abnormal.” Results: The 538 participants completed the online survey. Participants were able to reliably and consistently identify normal and abnormal head shapes with a Kappa Score >0.775. Furthermore, participants indicated that a correction of 70% is required in order for the cranial deformity to be regarded as “normal.” This threshold closely reflects a normal Cranial Index, which is a widely used morphometric outcome in craniosynostosis. Conclusion: Crowdsourcing provides an ideal method for capturing the general population's perspective on what constitutes a normal and acceptable head shape in children with sagittal craniosynostosis. Laypersons are able to reliably and consistently distinguish cranial deformities from a “normal” head shape. The public indicates a threshold correction of 70% in sagittal craniosynosis to regard it as a “normal” head shape. © 2020 by Mutaz B. Habal, MD.