title: Anterior plagiocephaly: epidemiology, clinical findings,diagnosis, and classification. A review.
abstract: BACKGROUND
  Anterior plagiocephaly due to the early unilateral fusion of the coronal suture is associated to a clinical phenotype characterized by the unilateral flattening of the frontal bone and the orbit and by the distortion and maldevelopment of adjacent cranial and facial bones. Homolateral anterior displacement of the ear and contralateral deviation of the nasal pyramid and mandible are other prominent clinical features. The differential diagnosis includes a variety of conditions characterized by facial asymmetry, namely, due to muscular alterations, anomalies of the visual function, congenital anomalies of the cervical spine and craniovertebral junction, abnormal pregnancy, and birth injuries. Anterior plagiocephaly is the direct cause of oculomotor anomalies, with a characteristic strabismus, and of progressive asymmetrical maldevelopment of the face, craniovertebral junction, and cervical spine.
  
  
  METHODS
  The medical literature was reviewed in regard to the epidemiology, clinical features, and radiological findings. Different categorization of the affected infants in specific subtypes according to the severity of the condition was analyzed. The aim was to contribute to a practical clinical classification to be utilized for the surgical indication and for predicting the prognosis according to the severity of the condition at presentation.
  
  
  CONCLUSIONS
  Anterior plagiocephaly represents the most challenging simple suture craniosynostosis. The clinical differential diagnosis with other forms of cranial asymmetry is possible on the grounds of mere clinical findings. A classification system is necessary not only for the establishment of surgical planning but also to predict the late cosmetic and functional outcomes.
authors.affiliation: Paediatric Neurosurgery, Catholic University Medical School, A. Gemelli Hospital, L.go A. Gemelli 8, 00168, Rome, Italy.
authors.forename: Concezio
authors.initials: C
authors.lastname: Di Rocco
authors.forename: Giovanna
authors.initials: G
authors.lastname: Paternoster
authors.forename: Massimo
authors.initials: M
authors.lastname: Caldarelli
authors.forename: Luca
authors.initials: L
authors.lastname: Massimi
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Tamburrini
mesh_terms: D016208:Databases, Factual / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D005260:Female; D005624:Frontal Bone / Q000002:abnormalities* / Q000473:pathology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D059041:Plagiocephaly / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D011296:Prenatal Diagnosis; D014057:Tomography, X-Ray Computed