title: Elevated levels of transforming growth factors beta 2 and beta 3 in lambdoid sutures from children with persistent plagiocephaly.
abstract: OBJECTIVE
  To analyze the pertinent history and physical findings specific to the subset of patients with a progressive posterior skull deformity, requiring surgery to correct their deformity.
  
  
  METHODS
  Since the Academy of Pediatrics issued its recommendation on supine positioning of infants to prevent sudden infant death syndrome (SIDS) in 1992, 73 children have presented to the University of Virginia Craniofacial Anomalies Clinic with posterior-skull deformities. The majority were successfully managed with conservative therapy, but in six patients, the deformity was severe and persistent, requiring surgical correction. All six children were older (7.5-12 mo), presenting with more severe morphologic appearances and a higher incidence of associated neurodevelopmental delay. Three had family backgrounds of isolated craniosynostosis.
  
  
  METHODS
  Characteristics of these patients were examined to determine why they may have differed from those that responded to conservative management. Immunohistochemical staining of their lambdoid sutures was performed.
  
  
  RESULTS
  Significantly increased staining for TGF-beta 2 and TGF-beta 3, potent stimulators of bone cell growth and differentiation, was seen in all 'affected' sutures from the flattened side of the skull, compared to unaffected sutures from the protruding side of the skull-a pattern similar to that seen during normal bony obliteration of calvarial sutures.
  
  
  CONCLUSIONS
  The majority of patients with posterior plagiocephaly associated with positioning responded to conservative management, while a small subset of patients with persistent posterior skull deformation required surgical intervention. A genetic basis for the latter patients' persistent plagiocephaly, rather than positioning, cannot be ruled out. Genetics, prolonged external pressure against the sutures, or a combination of these factors may lead to permanently raised levels of growth factors in 'affected' sutures.
authors.affiliation: Department of Plastic Surgery, Health Sciences Center, University of Virginia, Charlottesville 22908, USA.
authors.forename: K Y
authors.initials: KY
authors.lastname: Lin
authors.forename: A A
authors.initials: AA
authors.lastname: Nolen
authors.forename: T J
authors.initials: TJ
authors.lastname: Gampper
authors.forename: J A
authors.initials: JA
authors.lastname: Jane
authors.forename: L A
authors.initials: LA
authors.lastname: Opperman
authors.forename: R C
authors.initials: RC
authors.lastname: Ogle
mesh_terms: D002454:Cell Differentiation; D002455:Cell Division; D002657:Child Development; D004396:Coloring Agents; D003393:Cranial Sutures / Q000002:abnormalities* / Q000737:chemistry / Q000473:pathology / Q000601:surgery; D003398:Craniosynostoses / Q000235:genetics / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D003399:Craniotomy; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D015994:Incidence; D007223:Infant; D008297:Male; D009048:Motor Skills / Q000502:physiology; D009123:Muscle Hypotonia / Q000209:etiology; D009777:Occipital Bone / Q000002:abnormalities* / Q000737:chemistry / Q000473:pathology / Q000601:surgery; D010294:Parietal Bone / Q000002:abnormalities* / Q000737:chemistry / Q000473:pathology / Q000601:surgery; D011312:Pressure; D013398:Sudden Infant Death / Q000517:prevention & control; D016683:Supine Position; D016212:Transforming Growth Factor beta / Q000032:analysis*
chemical_list: D004396:Coloring Agents; D016212:Transforming Growth Factor beta