Matushita Hamilton, Alonso Nivaldo, Cardeal Daniel Dante, Andrade Fernanda Gonçalves de
Department of Neurosurgery, Division of Pediatric Neurosurgery, University of São Paulo, São Paulo, Brazil,
Childs Nerv Syst. 2014 Jul;30(7):1217-24. doi: 10.1007/s00381-014-2414-7. Epub 2014 Apr 12.
The clinical diagnosis of most common single-suture craniosynostosis is easily set, based on the stereotype of deformities and knowledge of the mechanisms of cranial deformations. However, synostosis of unilateral lambdoid suture, probably due to its lower incidence and similarity with other non-synostotic deformities affecting the posterior portion of the skull, makes its clinical diagnosis more difficult and imprecise. The aim of this study is to evaluate the most easily and accurate clinical characteristics to be recognized in the synostotic occipital plagiocephaly.
This study consisted of clinical evaluation of eight patients with synostotic occipital plagiocephaly, whose diagnosis was further corroborated by computed tomography.
We identified the following: unilateral occipital flattening in eight out of eight patients (100 %), bulging of ipsilateral mastoid process in eight out of eight (100 %), "edge effect" of ipsilateral lambdoid suture in eight out of eight (100 %), inferior deviation of the ear in eight out of eight (100 %), "Dumbo" ears in eight out of eight (100 %), horizontal slant of the bimastoid line in seven out of eight (87.5 %), tilt of the head viewed from behind in seven out of eight (87.5 %), trapezoidal contour of the skull in top view in six out of eight (75 %), contralateral parietal bossing in six out of eight (75 %), and bossing of the contralateral forehead three out of eight (37.5 %).
The most important clinical features specific to the clinical diagnosis of synostotic occipital plagiocephaly, not present in the positional posterior plagiocephaly, were bulging of the ipsilateral mastoid process, edge effect of the synostotic lambdoid suture, tilt of the head, and slant of the bimastoid line viewed from behind, inferior deviation of the ear, and contralateral parietal bossing.
基于颅骨畸形的刻板印象和颅骨变形机制的知识，大多数常见单缝颅缝早闭的临床诊断容易确立。然而，单侧人字缝早闭可能因其发病率较低且与影响颅骨后部的其他非缝早闭畸形相似，导致其临床诊断更加困难且不准确。本研究的目的是评估在缝早闭性枕部斜头畸形中最容易且准确识别的临床特征。
本研究包括对8例缝早闭性枕部斜头畸形患者的临床评估，其诊断通过计算机断层扫描进一步得到证实。
我们发现以下特征：8例患者中有8例（100%）存在单侧枕部扁平，8例中有8例（100%）同侧乳突突出，8例中有8例（100%）同侧人字缝出现“边缘效应”，8例中有8例（100%）耳朵向下偏移，8例中有8例（100%）出现“小飞象”耳，8例中有7例（87.5%）双侧乳突线水平倾斜，8例中有7例（87.5%）从后方观察头部倾斜，8例中有6例（75%）从头顶观察颅骨呈梯形轮廓，8例中有6例（75%）对侧顶骨膨隆，8例中有3例（37.5%）对侧额部膨隆。
缝早闭性枕部斜头畸形临床诊断所特有的、而体位性后部斜头畸形中不存在的最重要临床特征为同侧乳突突出、缝早闭人字缝的边缘效应、头部倾斜、从后方观察双侧乳突线倾斜、耳朵向下偏移以及对侧顶骨膨隆。
