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Updated: Feb 12, 2026
Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
Published on: November 4, 2025
Incidence of Cranial Base Suture Fusion in Infants with Craniosynostosis
Daniel M Mazzaferro1,2, Sanjay Naran1,2, Ari M Wes1,2
1Philadelphia, Pa.; and Winston-Salem, N.C.
Insights
Syndromic craniosynostosis is linked to significantly higher rates of cranial base suture fusion in infants compared to nonsyndromic cases and controls. Nonsyndromic craniosynostosis shows similar fusion patterns to unaffected individuals.
Area of Science:
- Craniofacial development and pediatric surgery.
- Genetics and developmental biology.
Background:
- Cranial base sutures are critical for facial and cranial growth.
- Craniosynostosis involves premature fusion of skull sutures.
Purpose of the Study:
- To compare the incidence and location of cranial base suture fusion.
- To differentiate fusion patterns between syndromic, nonsyndromic craniosynostosis, and controls.
Main Methods:
- Analysis of computed tomographic scans from 140 patients (55 syndromic, 64 nonsyndromic, 21 controls).
- Grading of cranial vault and base suture/synchondrosis fusion by craniofacial surgeon and neuroradiologist.
- Statistical comparison of fusion rates, locations, age, and diagnosis.
Main Results:
- Syndromic patients (average age 3.6 months) had over three times more fused cranial base sutures than nonsyndromic patients (5.4 months) and controls (5.1 months).
- Syndromic cases showed increased fusion in coronal branches, squamosal arch, and posterior intraoccipital synchondrosis.
- Nonsyndromic patients exhibited fusion rates and locations similar to controls.
Conclusions:
- Syndromic craniosynostosis in infancy is associated with elevated cranial base suture fusion, impacting craniofacial growth.
- Nonsyndromic craniosynostosis presents similar cranial base suture fusion patterns to controls.
- A low rate of "normal" cranial base suture closure exists in infancy with unknown implications.
Background:
Cranial base sutures are important drivers of both facial and cranial growth. The purpose of this study was to compare the incidence and location of cranial base suture fusion among three groups: nonaffected controls, patients with nonsyndromic craniosynostosis, and patients with syndromic craniosynostosis.
Methods:
Patients and computed tomographic scans were accrued from the authors' prospective craniofacial database. Computed tomographic scans were graded on the frequency of cranial vault and cranial base suture/synchondrosis fusion (0, open; 1, partially/completely fused) by an attending craniofacial surgeon and neuroradiologist. Statistical comparisons were conducted on location and rates of fusion, age, and diagnosis.
Results:
One hundred forty patients met inclusion criteria: 55 syndromic, 64 nonsyndromic, and 21 controls. Average age at computed tomography of syndromic patients (3.6 ± 3.1 months) was younger than that of nonsyndromic patients (5.4 ± 3.1 months; p = 0.001) and control subjects (5.1 ± 3.2 months; p = 0.058). Syndromic craniosynostotic patients had over three times as many cranial base minor sutures fused (2.2 ± 2.5) as nonsyndromic craniosynostosis patients (0.7 ± 1.2; p < 0.001) and controls (0.4 ± 0.8; p = 0.002), whose rates of fusion were statistically equivalent (p = 0.342). Syndromic craniosynostosis patients had a greater frequency of cranial base suture fusion in the coronal branches, squamosal arch, and posterior intraoccipital synchondrosis (p < 0.05).
Conclusions:
Patients with syndromic craniosynostosis have higher rates of cranial base suture fusion in infancy, especially in the coronal arches, and this may have significant implications for both cranial and facial growth. In contrast, patients with nonsyndromic craniosynostosis have similar rates and sites of cranial base suture fusion as controls. Interestingly, there is a low, "normal," rate of cranial base suture/synchondrosis closure in infancy, the implications of which are unknown.
Clinical Question/Level Of Evidence:
Risk, III.
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