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Craniosynostosis - Description of different types
The different sutures and description of the awkward head shape when one or more sutures fuse are as follows:
Saggital - Side view
The Saggital suture runs from the front of the head to the back of the skull.
Fusion of the suture results in a long, narrow skull which may or may not include bulging of both the front and back of the head. The shape of a skull affected with Saggital Craniosynostosis is also known as scaphocephaly. Saggital Craniosynostosis is the most Common form of and estimated to happen one in 1000 births.
It is thought that disproportion in the size of the pelvis of the mother and the size of the fetal head can cause Saggital Craniosynostosis. The limited room for growth is thought to bring the two parietal bones together too early creating the synostosis in the pelvis before birth. This is why Saggital Craniosynostosis is often seen in first pregnancies. Also, boys have larger heads and that is why it is thought more boys than girls are affected with Saggital Synostosis.
Saggital - top view
Even with these thoughts on Saggital Craniosynostosis there is nothing that an expectant mother can do to prevent Craniosynostosis. There is still not enough known about Saggital and any other form of Craniosynostosis. Research is still being discovered for the causes of premature suture closure.
Unilateral Craniosynostosis
When one suture is fused that is known as Unilateral (left or right) Coronal synostosis. The shape of the head is sometimes referred to as Plagiocephaly (which should not be confused with positional Plagiocephaly.) The forehead on the effected side is flattened and swept back with the eye in its socket. Unilateral Craniosynostosis can give the appearance that one eye is wider open then the other which is caused by the lack of orbit around the affected eye.
When both sutures are fused that is known as bicoronal synostosis. The head is short and wide with the head shape being referred to as brachycephalic. There is a lack of growth with both eye orbits which can cause bulging of the eyes. The back of the head might appear flat with a bulging of the skull around the ears. The skull tends to tower upwards as it continues to grow.
Lambdoid - back view
The Lambdoid suture is located on the back of the skull. It has a right and left side and is shaped like an upside down "V.
One key marker for fusion of the Lambdoid suture is a low bump behind the ear on the same side as the fused suture. Another good way to determine if the Lambdoid suture is closed is to look and see if the ear on the same side as the posterior skull flatness is pulled backwards and sticks out more. If the ear is forward on the flat side, with respect to the opposite ear, then a skull deformation should be suspected instead of a fused suture. When viewed from above, the affected side of the back of the head is flatter than the opposite side.
Lambdoid Craniosynostosis is the rarest form of Craniosynostosis and fusion of both Lambdoid sutures is rarer. The diagnosis of Lambdoid synostosis is the most difficult to make because on plain skull x-rays the Lambdoid suture is frequently misdiagnosed as being fused shut. Ideally, the diagnosis of Lambdoid synostosis is made by CT scans, read at an experienced center.
Cloverleaf Craniosynostosis
Also known as Kleeblattschadel. Premature fusion of the coronal, Lambdoid and posterior Saggital sutures results in a cloverleaf skull. This is the rarest form of Craniosynostosis and evidence of closure will be obvious at birth. Due to the severity of multiple sutures being fused children with Cloverleaf should be closely followed by pediatric neurosurgeons, pediatric craniofacial surgeons, and a team of doctors to follow up through childhood and possibly adulthood.
Helpful links and resources:
www.CAPPSKids.org
www.Craniokids.org/support
www.alexandrasphate.org
www.beyondaglimpse.com/support
By Melanie Harper - www.beyondaglimpse.com
Metopic Craniosynostosis:
The Metopic suture begins at the nose and continues to meet the Saggital suture. Metopic Craniosynostosis results in a narrow, triangular forehead with pinching of the temples laterally (trigonocephaly). The Metopic Suture is the first and only suture which normally fuses early in childhood (normally around 6 to 8 mths but in some cases as early as 3 months.) Metopic Craniosynostosis is one of the least common forms of Craniosynostosis. However, sometimes the early fusion of the Metopic suture will cause a Metopic ridge with no trigonocephaly. In cases of a Metopic ridge surgical intervention may not be needed. If your child has a Metopic ridging with no trigonocephaly parents should be sure to consult a craniofacial specialist. Even if they are advised to be wait and see its best to research and ask questions. In true Metopic Craniosynostosis with the evidence of trigonocephaly (a triangular forehead and narrowing to the skull), whether this narrowing is mild or severe, many experienced surgeons will recommend that the infant's skull should be surgically repaired.Saggital Craniosynostosis
Saggital - Side viewThe Saggital suture runs from the front of the head to the back of the skull.
Fusion of the suture results in a long, narrow skull which may or may not include bulging of both the front and back of the head. The shape of a skull affected with Saggital Craniosynostosis is also known as scaphocephaly. Saggital Craniosynostosis is the most Common form of and estimated to happen one in 1000 births.
It is thought that disproportion in the size of the pelvis of the mother and the size of the fetal head can cause Saggital Craniosynostosis. The limited room for growth is thought to bring the two parietal bones together too early creating the synostosis in the pelvis before birth. This is why Saggital Craniosynostosis is often seen in first pregnancies. Also, boys have larger heads and that is why it is thought more boys than girls are affected with Saggital Synostosis.
Saggital - top viewEven with these thoughts on Saggital Craniosynostosis there is nothing that an expectant mother can do to prevent Craniosynostosis. There is still not enough known about Saggital and any other form of Craniosynostosis. Research is still being discovered for the causes of premature suture closure.
Coronal Synostosis
The coronal sutures begin at the ear and continue superiorly to the top of the skull to meet the Saggital suture. One or both sutures may be involved . Unilateral CraniosynostosisWhen one suture is fused that is known as Unilateral (left or right) Coronal synostosis. The shape of the head is sometimes referred to as Plagiocephaly (which should not be confused with positional Plagiocephaly.) The forehead on the effected side is flattened and swept back with the eye in its socket. Unilateral Craniosynostosis can give the appearance that one eye is wider open then the other which is caused by the lack of orbit around the affected eye.
When both sutures are fused that is known as bicoronal synostosis. The head is short and wide with the head shape being referred to as brachycephalic. There is a lack of growth with both eye orbits which can cause bulging of the eyes. The back of the head might appear flat with a bulging of the skull around the ears. The skull tends to tower upwards as it continues to grow.Lambdoid Craniosynostosis:
Lambdoid - back viewThe Lambdoid suture is located on the back of the skull. It has a right and left side and is shaped like an upside down "V.
One key marker for fusion of the Lambdoid suture is a low bump behind the ear on the same side as the fused suture. Another good way to determine if the Lambdoid suture is closed is to look and see if the ear on the same side as the posterior skull flatness is pulled backwards and sticks out more. If the ear is forward on the flat side, with respect to the opposite ear, then a skull deformation should be suspected instead of a fused suture. When viewed from above, the affected side of the back of the head is flatter than the opposite side.
Lambdoid Craniosynostosis is the rarest form of Craniosynostosis and fusion of both Lambdoid sutures is rarer. The diagnosis of Lambdoid synostosis is the most difficult to make because on plain skull x-rays the Lambdoid suture is frequently misdiagnosed as being fused shut. Ideally, the diagnosis of Lambdoid synostosis is made by CT scans, read at an experienced center.
Cloverleaf Craniosynostosis:
Cloverleaf CraniosynostosisAlso known as Kleeblattschadel. Premature fusion of the coronal, Lambdoid and posterior Saggital sutures results in a cloverleaf skull. This is the rarest form of Craniosynostosis and evidence of closure will be obvious at birth. Due to the severity of multiple sutures being fused children with Cloverleaf should be closely followed by pediatric neurosurgeons, pediatric craniofacial surgeons, and a team of doctors to follow up through childhood and possibly adulthood.
Helpful links and resources:
www.CAPPSKids.org
www.Craniokids.org/support
www.alexandrasphate.org
www.beyondaglimpse.com/support
By Melanie Harper - www.beyondaglimpse.com
You may also be interested in...
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- Positional flattening
- Why is the Back of My Baby’s Head Flat?
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Bethany Learn
This article should cover how craniosacral therapy can help with many of these cases. I have several friends whose babies were benefited by it.
Concerned Parent
Craniosacral therapy can not benefit true cases of craniosynostosis. If the sutures are already fused no amount of repositioning or outward therapy can move those sutures because they are hardened bone once they fuse. Craniosacral therapy can help with positional plagiocephaly in which the sutures are fully opened but the skull is flattened due to outward pressure placed on it. Please do your research before misleading parents facing the diagnosis and treatment of craniosynostosis. Craniosacral therapy for craniosynostosis is not avisable and could be dangerous. For many craniosynostosis is something that can last throughout childhood into adulthood with sutures sometimes refusing and causing damage as the child grows through growth spurts. Remember only 80% of the brain and skull are grown at the age of 2 other growth takes shape throughout childhood and some adulthood.
KMG
Bethany, while craniosacral therapy may be beneficial to positional "defects" (a word I hate), it can not treat craniosynostosis. Once a suture is fused, the only way to correct it is surgically. I'm not a doctor, this is simply how I understand it.
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