Workup
Imaging Studies
When careful examination of the cranial shape cannot establish the diagnosis, skull radiographs can be obtained.
Perform skull radiography with anterior-posterior, lateral, and Water views. Prematurely fused sutures are easily identified by the absence of sutures and associated ridging of the suture line. Sutures either are not visible or have evidence of sclerosis.
Cranial CT scan with 3-dimensional reconstruction is not required in most infants. It is sometimes performed when surgery is being considered, or when radiograph results are equivocal. [9]
Sagittal synostosis and the associated scaphocephaly seen on skull radiograph and 3-dimensional craniofacial CT scan.
Nuclear medicine isotope studies are of limited value.
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Other Tests
Endocrine evaluation: Order thyroid and parathyroid studies when associated features suggest these diagnoses.
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Media Gallery
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Diagram of a neonate's skull demonstrating the location of the sutures.
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Frontal view showing a fused and ridged metopic suture on 3-dimensional CT.
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CT image demonstrating features of secondary craniosynostosis with cerebral atrophy. Cerebral atrophy is not present in primary craniosynostosis.
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Positional molding. Note the anterior displacement of the right occiput and of the right frontal region on the same side, which differentiate positional molding from posterior plagiocephaly craniosynostosis.
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Posterior view of 3-dimensional cranial CT demonstrating early fusion of the lambdoid suture.
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Isolated fusion of the metopic suture. Note that the remaining sutures are open.
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Trigonocephaly. Note the triangular shape of the head.
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Infant with primary craniosynostosis. The specific deformity of the skull is Kleeblattschadel or cloverleaf skull.
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Skull deformities associated with single suture synostosis.
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Positional plagiocephaly. Note anterior position of the ear on the side with occipital flattening.
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Sagittal synostosis and the associated scaphocephaly seen on skull radiograph and 3-dimensional craniofacial CT scan.
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Sagittal synostosis before and after cranial vault surgery and the associate improvement of scaphocephaly.
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Unilateral coronal deformity with retrusion of the orbit and harlequin eye deformity. Note the ipsilateral deviation of the nasal radix and the contralateral deviation of the nasal tip.
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Fusion of coronal sutures bilaterally. Note the increase transverse dimension and retrusion of the orbital rim.
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Intraoperative view of bilateral coronal synostosis. Note the decreased anterior-posterior dimension, increased transverse width and retruded orbital rim.
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Pre- and postoperative photos of metopic synostosis. Note the prominent forehead keel corrected after surgical repair.
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