Lee Jonathan, Naran Sanjay, Mazzaferro Daniel, Wes Ari, Anstadt Erin E, Taylor Jesse, Goldstein Jesse, Bartlett Scott, Losee Joseph
From the Division of Plastic and Reconstructive Surgery, Baystate Health System, Springfield, Mass.
Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Park Ridge, Ill.
Plast Reconstr Surg Glob Open. 2023 May 19;11(5):e5011. doi: 10.1097/GOX.0000000000005011. eCollection 2023 May.
Unilateral lambdoid craniosynostosis is differentiated from deformational plagiocephaly primarily by assessing the cranium from posterior and bird's-eye views. Findings include posterior displacement of the ipsilateral ear, ipsilateral occipitomastoid bossing, ipsilateral occipitoparietal flattening, contralateral parietal bossing, and contralateral frontal bossing. Diagnosis based off facial morphology may be an easier approach because the face is less obstructed by hair and head-coverings, and can easily be assessed when supine. However, frontofacial characteristics of unilateral lambdoid craniosynostosis are not well described.
A retrospective cohort review of patients with isolated, unilateral lambdoid craniosynostosis from the Children's Hospital of Pittsburgh and the Children's Hospital of Philadelphia was performed. Preoperative frontal and profile photographs were reviewed for salient characteristics.
Nineteen patients met inclusion criteria. Eleven patients had left lambdoid craniosynostosis, and eight had right lambdoid craniosynostosis. All patients were nonsyndromic. Patients demonstrated contralateral parietal bossing and greater visibility of the ipsilateral ear. Contralateral frontal bossing was mild. The orbits were tall and turricephaly was present in varying severity. Facial scoliosis as a C-shaped deformity was present in varying severity. The nasal root and chin pointed to the contralateral side.
The combination of greater visibility of the ipsilateral ear, contralateral parietal bossing, and C-shaped convex ipsilateral facial scoliosis are hallmark frontofacial features of unilateral lambdoid craniosynostosis. Although the ipsilateral ear is more posterior, the greater visibility may be attributed to lateral displacement from the mastoid bulge. Evaluation of long-term postoperative results is needed to assess if this pathognomonic facial morphology is corrected following posterior vault reconstruction.
单侧人字缝早闭主要通过从后方和鸟瞰视角评估颅骨来与变形性斜头畸形相鉴别。其表现包括同侧耳朵后移、同侧枕乳突隆突、同侧枕顶扁平、对侧顶骨隆突和对侧额骨隆突。基于面部形态进行诊断可能是一种更简便的方法，因为面部受头发和头部覆盖物的遮挡较少，且在仰卧位时易于评估。然而，单侧人字缝早闭的额面部特征尚无详细描述。
对匹兹堡儿童医院和费城儿童医院的孤立性单侧人字缝早闭患者进行回顾性队列研究。回顾术前的正面和侧面照片以寻找显著特征。
19例患者符合纳入标准。11例为左侧人字缝早闭，8例为右侧人字缝早闭。所有患者均为非综合征性。患者表现出对侧顶骨隆突以及同侧耳朵更易被看到。对侧额骨隆突较轻。眼眶较高，不同程度地存在塔头畸形。不同程度地存在呈C形畸形的面部脊柱侧弯。鼻根和下巴指向对侧。
同侧耳朵更易被看到、对侧顶骨隆突以及同侧呈C形凸起的面部脊柱侧弯相结合是单侧人字缝早闭的典型额面部特征。尽管同侧耳朵位置更靠后，但更易被看到可能归因于其从乳突隆起处侧向移位。需要评估长期术后结果，以确定在后颅 vault 重建后这种特征性面部形态是否得到纠正。
