Positional skull deformities in children: skull deformation without synostosis

Abstract

Most positional head deformities appear to be related with the children's positioning for sleeping. We have not confirmed macrocephaly as a contributing factor for positional deformities. The distribution of extracerebral CSF and the presence of abnormal collections of fluid in children with positional head deformities do not seem to be related with the findings of pericerebral CSF encountered in children with benign extracerebral collections of fluid. In our view, brain pulsations, transmitted to these accumulations of CSF, play an important part in the development of the infants' skull deformities (p=0.02). The findings of enlarged CSF spaces in children with nonsynostotic skull deformation constituted an age-related event, as these collections tended to disappear as the children grew older (p=0.04).

The moulded baby syndrome: incidence and risk factors regarding 1,001 neonates

“…Unlike what we expected and what had been published previously [8,13,15,17,21], multiple-birth pregnancy was almost never associated with MBS in our study population, whereas an occipital flattening was described by Peitsch et al in up to 56% of twins [21] and an incidence of 44% of postural asymmetry was reported by Hamanishi and Tanaka [13]. As to infant-dependent factors, the observation that boys are more frequently affected than girls in terms of torticollis and plagiocephaly has frequently been published [4,5,7,15,16,[19][20][21] and could be explained by a greater average birth length. Unlike what could be expected, birth weights and head circumferences were not significant risk factors for MBS, which has also been observed [21].…”

The earliest evidence of true lambdoid craniosynostosis: the case of “Benjamina”, a Homo heidelbergensis child

“…CT reconstruction also ascertained that the intracranial volume of Cranium 14 was approximately 1,200 cm 3 [23]. In addition, the internal surface of the specimen showed marked endocranial convolutions and signs of enlarged subarachnoid spaces, which have been also documented in cases of positional plagiocephaly and of true craniosynostosis [15,30,38]. Regarding etiology of the synostosis, Gracia et al mention the possibility of intrauterine trauma, fetal head constraint, or torticollis The space between the suture borders suggests that there was probably one more supernumerary ossicle.…”

“…Posterior plagiocephaly refers to an asymmetric shape of the posterior part of the cranium that can be due either to true parieto-occipital bone fusion or to a deformed occiput by external forces [14,19,22,25,30,31,36,38]. The distinction between these two conditions has proven to be quite difficult and some authors include a "sticky" lambdoid suture within the group of lambdoid synostosis [22,25,31].…”

“…Much more frequent is the so-called deformational or positional posterior plagiocephaly, which has been related with the sleeping supine position recommended by the American Academy of Pediatrics to prevent the sudden infant death syndrome [19,22,30,36]. In fact, the prevalence of posterior plagiocephaly without synostosis has increased in recent years and is estimated in 33:10,000 [22,30,36]. This differentiation is important, as deformational plagiocephaly rarely requires surgical treatment while true lambdoid synostosis does.…”

Paleopathological Findings of Dry Skulls with Plagiocephaly

“…Occipital positional plagiocephaly (Fig. 2) is associated with asymmetrical "parallelogram" skull shape, unilateral parieto-occipital flattening, ipsilateral frontal bossing, contralateral frontal flattening and occipital bossing, asymmetry of external nose (nasal root is in a midline position but nasal bones and piriform aperture are deviated on the contralateral side), asymmetry of the orbits (contralateral orbit is situated low then ipsilateral orbit), asymmetry of the ear position (ipsilateral ear is situated anterior and superior) (9,11,13,16,21). Positional plagiocephaly can be classified as mild (without facial asymmetry) or severe (with facial asymmetry) (3).…”