Posterior plagiocephaly: craniosynostosis or skull molding?

Abstract

The surgical indication in posterior plagiocephaly has been and still is a subject of discussion. Unlike other types of craniosynostosis, this particular type of cranial deformity does not show the typical radiological findings that are encountered in cases of prematurely fused cranial sutures. Furthermore, in most cases even the inspective evaluation during the surgical operation fails to demonstrate the actual fusion of the lambdoid suture. The mild clinical manifestations of the condition and the observation that physical maneuvers, such as, forexample, wearing constrictive helmets, may suffice to correct the malformation add further uncertainties to surgical correction. In recent years, there has been an apparent increase in the incidence of posterior plagiocephaly following changes in the sleeping habits of infants as a result of the recommendation of the American Task Force on Infant Position and Sudden Infant Death Syndrome, which has favored a supine position. The phenomenon has prompted a series of reports aimed at differentiating posterior plagiocephaly resulting from a true early fusion of the lambdoid suture, which requires early surgical correction, from a deformational modification of the calvarium caused by prolonged and excessive pressure exerted on the posterior aspect of the skull in early infancy, which may not need surgical treatment. Unfortunately, in spite of great interest in the problem, the differential diagnosis between the two conditions remains obscure. In clinical practice, the surgical indication appears still to be based mainly on the evidence of a rapidly worsening cranial deformation rather than on sound objective criteria.