Skeletal Deformity in Patients With Unilateral Coronal Craniosynostosis: Perceptions of the General Public

Abstract

Study design: A two-alternative forced choice design was used to gather perceptual data regarding unicoronal synostosis (UCS).

Objective: Cranial vault remodeling aims at improving the aesthetic appearance of infants with UCS by reshaping the forehead and reducing the potential for psychosocial discrimination. People's perception of craniofacial deformity plays a role in the stigma of deformity. The purpose of this study is to examine the relationship between objective skull deformity in UCS patients and laypersons' perception of skull normality.

Methods: Forty layperson skull raters were recruited from the general public. Skull raters were asked to categorize 45 infant skull images as normal or abnormal. Twenty-one of the images were UCS skulls, and 24 were normal skulls. Skulls were displayed briefly on a computer to simulate a first impression scenario and generate a perceptual response. A χ ² analysis and mixed-effects regression model were used to analyze the response data.

Results: Members of the general public were good at distinguishing between skull groups, χ ² (1) = 281.97, P < .001. In addition, skull raters' responses were predicted by the severity of deformity in the UCS skulls (b = -0.10, z = -2.6, P = .010, CI: -0.18, -0.02). A skull with a deformity value of 2.8 mm (CI: 1.8, 4.1) was equally likely to be rated normal or abnormal.

Conclusions: This is the first study to investigate the relationship between objective skull deformity in UCS and public perception. Laypersons were good at distinguishing the difference between normal and UCS skulls, and their perceptions of normality were predicted by the degree of skull deformity.

Keywords: craniosynostosis; forehead; pediatric; unicoronal synostosis; virtual surgical planning.

Figure 1.

Distribution of surface distance values among the UCS skull cohort. UCS indicates unilateral coronal craniosynostosis.

Figure 2.

Examples of a skull model as they appeared on the computer screen. (A) An example of a normal 3D skull model generated for this study. (B) An example of a UCS 3D skull model generated for this study.

Figure 3.

Experimental setup. Skull raters viewed the skull images on a laptop computer screen and were asked to categorize each skull as “normal” or “abnormal.” Responses were recorded on an answer sheet. Each skull was displayed for 0.3 seconds, and raters had 5 seconds to record a response.

Figure 4.

Overview of the workflow used to determine surface distance values.

Figure 5.

Results of the χ ² analysis of skull rater responses.