We recently reviewed our series of craniofacial cases involving lambdoid stenosis (posterior plagiocephaly) and positional deformation. We now have 22 cases (who underwent surgery) with greater than 1 year follow up (range 1-7 years). We were impressed by the potential severity of the craniofacial deformity that can occur in what is often considered a positional deformation caused either by intrauterine conditions or by postnatal positioning. To decide which children were candidates for craniofacial reconstruction, we reviewed our cases and determined what we considered were appropriate criteria for craniofacial surgery. Among the 22 patients selected for surgery, 16 patients had changes in facial characteristics secondary to skull base and petrous ridge deformation, which often led to mandibular malalignment. In addition, 11 children were found to have developed scolosis of the face, similar to that seen in anterior plagiocephaly. The long-term severity of these selected craniofacial deformities may be markedly reduced if these children are operated on early with craniofacial reconstruction techniques. The removal of the lambdoid sutures, which appears to apply a twisting or torque effect on the facial structures and skull base, assisted in the children's further normal cranial development. In the children that were operated on before 1 year of age, most of the facial asymmetry was corrected. In addition, we observed that several of the children showed correction of the malignment of the ears, a common finding in these cases. Three-dimensional reconstructions have been extremely helpful in documenting the abnormalities of the skull base and sutural patterns and in planning the surgical approaches. All the patients had either a Marchac transposition or a bandeau/forehead type reconstruction. There were no long-term complications, and the esthetic results were considered good to excellent.