Francel P C, Park T S, Marsh J L, Kaufman B A
Department of Neurosurgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA.
J Neurosurg. 1995 Oct;83(4):733-6. doi: 10.3171/jns.1995.83.4.0733.
Frontal plagiocephaly may arise from either synostotic or deformational forces. Deformational causes of frontal plagiocephaly can be distinguished from synostotic causes by differences seen on physical examination, which can then be confirmed by skull x-ray films and if necessary three-dimensional computerized tomography (CT). Unilateral coronal synostosis is the main synostotic cause of frontal plagiocephaly, although it has also been seen with fusion of the frontozygomatic suture. In several syndromes presenting with bilateral coronal synostosis, fusion of the frontosphenoidal and frontoethmoidal sutures is also present. The authors report, for perhaps the first time, a case showing synostotic frontal plagiocephaly secondary to fusion of the frontosphenoidal suture alone. Although the phenotypic appearance is superficially similar to that seen in unilateral coronal synostosis, analysis of the cranial base shows markedly different effects: angulation of the anterior cranial base with respect to the posterior cranial base away from the synostotic side and angulation of the posterior cranial base with respect to the midpalatal suture also away from the synostotic side. In unilateral coronal synostosis, both angulations are toward the synostotic side. These effects on the cranial base alter its relationship to the cranial vault and the facial skeleton. Most important, frontal plagiocephaly secondary to fusion of the frontosphenoidal suture should not be overlooked as being deformational. Because this fusion is difficult or impossible to visualize by skull x-ray films, three dimensional CT must be obtained in cases that are not clearly identified as deformational plagiocephaly by physical examination.
额部斜头畸形可能由骨性融合或变形因素引起。通过体格检查发现的差异，可将额部斜头畸形的变形原因与骨性融合原因区分开来，随后可通过颅骨X光片进行确认，必要时还可进行三维计算机断层扫描（CT）。单侧冠状缝早闭是额部斜头畸形的主要骨性融合原因，不过在额颧缝融合时也可见到。在一些表现为双侧冠状缝早闭的综合征中，额蝶缝和额筛缝也会融合。作者或许首次报告了一例仅因额蝶缝融合继发的骨性融合性额部斜头畸形病例。尽管其表型外观与单侧冠状缝早闭的情况表面相似，但对颅底的分析显示出明显不同的影响：前颅底相对于后颅底向远离骨性融合侧成角，后颅底相对于腭中缝也向远离骨性融合侧成角。在单侧冠状缝早闭中，这两个成角方向均朝向骨性融合侧。这些对颅底的影响改变了它与颅顶和面部骨骼的关系。最重要的是，不应忽视因额蝶缝融合继发的额部斜头畸形为变形性的。由于这种融合在颅骨X光片上很难或无法显示，对于体格检查未明确诊断为变形性斜头畸形的病例，必须进行三维CT检查。
