title: Occipital plagiocephaly: unilateral lambdoid synostosis versus positional plagiocephaly.
abstract: OBJECTIVE
  We defined parameters that could differentiate between positional and synostotic plagiocephaly and defined a diagnostic chart for decision making.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  We examined 411 children with non-syndromic skull abnormalities between January 2011 and December 2012.
  
  
  METHODS
  A total of 8 infants under 1 year of age with proven unilateral non-syndromic lambdoid synostosis (LS) and 261 children with positional deformity were examined to outline the specific clinical features of both diagnoses. After clinical examination, an ultrasound revealed either a closed suture suggestive of LS or a patent lambdoid suture suggestive of positional deformity. For patients with synostosis, plain radiographs, MR imaging and follow-up examinations were performed. In cases of open sutures, only follow-ups were completed.
  
  
  METHODS
  Clinical, imaging, genesis and treatment differences between positional plagiocephaly and LS.
  
  
  RESULTS
  In all 8 cases of unilateral LS and 258 cases of positional plagiocephaly, the diagnosis was established by clinical examination alone. In three cases of positional plagiocephaly, diagnosis was determined after an additional ultrasonography. MR imaging revealed a unilateral tonsillar herniation in five of the eight children with LS and hydrocephalus in one child.
  
  
  CONCLUSIONS
  We have suggested a list of clinical features that specify the underlying cause of posterior plagiocephaly. An additional ultrasound scanning confirmed the diagnosis without any risks of ionising radiation or sedation as in a CT scan.
authors.affiliation: Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Linz
authors.affiliation: Department of Neurosurgery, Section of Pediatric Neurosurgery, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Collmann
authors.affiliation: Department of Orthodontics, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Meyer-Marcotty
authors.affiliation: Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Böhm
authors.affiliation: Department of Neurosurgery, Section of Pediatric Neurosurgery, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Krauss
authors.affiliation: Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Urs D
authors.initials: UD
authors.lastname: Müller-Richter
authors.affiliation: Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Ralf-Ingo
authors.initials: RI
authors.lastname: Ernestus
authors.affiliation: Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Wirbelauer
authors.affiliation: Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Kübler
authors.affiliation: Department of Orthodontics, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Tilmann
authors.initials: T
authors.lastname: Schweitzer
mesh_terms: D002648:Child; D003393:Cranial Sutures / Q000002:abnormalities / Q000000981:diagnostic imaging; D003398:Craniosynostoses / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009777:Occipital Bone / Q000002:abnormalities* / Q000000981:diagnostic imaging; D059041:Plagiocephaly / Q000175:diagnosis*; D011446:Prospective Studies; D011859:Radiography; D014463:Ultrasonography
keywords: Growth; Neurosurgery; Paediatric Practice; Paediatric Surgery