THE DIFFERENTIAL-DIAGNOSIS OF ABNORMAL HEAD SHAPES - SEPARATING CRANIOSYNOSTOSIS FROM POSITIONAL DEFORMITIES AND NORMAL VARIANTS

The correct differential diagnosis of an abnormal head shape in an inf ant or a child is vital to the management of this common condition. Es tablishing the presence of craniosynostosis, which warrants surgical c orrection, versus non-synostotic causes of head deformity, which do no t, is not always straightforward. This paper deals with three groups o f abnormal head shape that may cause diagnostic confusion: the spectru m of metopic synostosis; the dolichocephaly of prematurity versus sagi ttal synostosis; and the differential diagnosis of plagiocephaly. Spec ial emphasis has been placed on the problem of posterior plagiocephaly , in the light of recent evidence demonstrating that lambdoid synostos is has been overdiagnosed. Metopic synostosis presents as a wide spect rum of severity. Although only severe forms of the disorder are correc ted surgically, all cases should be monitored for evidence of developm ental problems, The dolichocephalic head shape of preterm infants is n on-synostotic In origin and is managed nonsurgically, The scaphocephal ic head shape resulting from sagittal synostosis requires surgical int ervention for correction, Posterior plagiocephaly may be due to unilam bdoid synostosis or positional molding, which have very different clin ical and imaging features, True lambdoid synostosis is rare. Most case s of posterior plagiocephaly are due to positional molding, which can usually be managed nonsurgically. Regardless of the suture(s) involved , sill children with confirmed craniosynostosis should be monitored fo r increased intracranial pressure and developmental problems.