Occipital plagiocephaly: unilateral lambdoid synostosis versus positional plagiocephaly
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Published on: February 5, 2019
Christian Linz1, Hartmut Collmann2, Philipp Meyer-Marcotty3
1Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany.
Insights
This study identifies key clinical features to distinguish positional plagiocephaly from lambdoid synostosis (LS) in infants. Ultrasound confirmed diagnoses, offering a safe alternative to radiation-based imaging for infant skull deformities.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Developmental Pediatrics
Background:
- Positional plagiocephaly and lambdoid synostosis (LS) are common infant skull deformities.
- Differentiating between these conditions is crucial for appropriate management.
- Accurate diagnosis impacts treatment strategies and patient outcomes.
Purpose of the Study:
- To define parameters distinguishing positional plagiocephaly from synostotic plagiocephaly.
- To develop a diagnostic chart for clinical decision-making.
- To outline specific clinical features of unilateral non-syndromic lambdoid synostosis (LS) and positional deformity.
Main Methods:
- Prospective study of 411 children with non-syndromic skull abnormalities.
- Clinical examination and ultrasound used to differentiate between LS and positional deformity.
- Radiographs and MR imaging employed for synostosis cases; follow-ups for all.
Main Results:
- Diagnosis by clinical examination alone in 8/8 LS cases and 258/261 positional plagiocephaly cases.
- Ultrasound confirmed diagnosis in 3 additional positional plagiocephaly cases.
- MR imaging identified unilateral tonsillar herniation in 5/8 LS cases and hydrocephalus in 1/8 LS case.
Conclusions:
- Clinical features can effectively specify the cause of posterior plagiocephaly.
- Ultrasound provides a safe, non-ionizing radiation diagnostic tool.
- This approach aids in differentiating positional deformity from lambdoid synostosis.
Objective:
We defined parameters that could differentiate between positional and synostotic plagiocephaly and defined a diagnostic chart for decision making.
Design:
Prospective study.
Setting:
We examined 411 children with non-syndromic skull abnormalities between January 2011 and December 2012.
Participants:
A total of 8 infants under 1 year of age with proven unilateral non-syndromic lambdoid synostosis (LS) and 261 children with positional deformity were examined to outline the specific clinical features of both diagnoses. After clinical examination, an ultrasound revealed either a closed suture suggestive of LS or a patent lambdoid suture suggestive of positional deformity. For patients with synostosis, plain radiographs, MR imaging and follow-up examinations were performed. In cases of open sutures, only follow-ups were completed.
Main Outcome Measure:
Clinical, imaging, genesis and treatment differences between positional plagiocephaly and LS.
Results:
In all 8 cases of unilateral LS and 258 cases of positional plagiocephaly, the diagnosis was established by clinical examination alone. In three cases of positional plagiocephaly, diagnosis was determined after an additional ultrasonography. MR imaging revealed a unilateral tonsillar herniation in five of the eight children with LS and hydrocephalus in one child.
Conclusions:
We have suggested a list of clinical features that specify the underlying cause of posterior plagiocephaly. An additional ultrasound scanning confirmed the diagnosis without any risks of ionising radiation or sedation as in a CT scan.
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