Pariatric Neururgery- Craniosynostosis, spma bifida
sutures include the metopic (m), coronal (c), sagittal (s), lambdoid (I) and squamosal (sq). In craniosynostosis, the anterior fontanel (af) may be open or closed.
Positional plagiocephaly is different than craniosynostosis. In positional plagiocephaly, the ear and possibly forehead on the side of the posterior flattening are displaced anteriorly, giving the head a parallelogram shape. Flattening may occur on the right, left or center occiput. Symmetric positional plagiocephaly can sometimes be difficult to distinguish from bilateral coronal craniosynostosis and imaging may be considered.
Sagittal craniosynostosis, the most common non-syndromic form, causes a long and narrow head. There may be prominence, or “bossing”, of the forehead and/or occiput.
Bilateral coronal craniosynostosis, the most common syndromic form, causes a short and wide head.
Unilateral coronal craniosynostosis causes a rotated appearance of the face, with flattening of the forehead and elevation of the orbital roof on the affected side along with rotation of the nose. Sometimes the anterior fontanel is somewhat displaced to the contralateral side.
Metopic craniosynostosis causes a triangular shape to the forehead when viewed from above. Eyes may be abnormally close together. Metopic ridging without the triangular shape is a normal variant and does not require surgical correction.
Lambdoid craniosynostosis is very rare and the only type that would cause flattening in the back of the head similar to positional plagiocephaly. With lambdoid craniosynostosis, however, the ear and possibly forehead on the side of the posterior flattening are displaced posteriorly, giving the head a trapezoidal shape.
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