Postural Plagiocephaly (Differential Diagnosis Cranisynostosis)

Figure kran_15_n.jpg: Postural posterior plagiocephaly on the left side in a 6-month-old girl. The view from behind exhibits a hairless left-sided parietooccipital region which is flattened, in contrast to the rounded corresponding right side (the flattening is at the same side as the hairless region). The cause is an abnormal posture with preferred torsion of the head to the left; therefore, a left-sided flattening results which is reversible if the abnormal pattern of posture is relieved. Figure kran_16a_n.jpg to kran_16c_n.jpg: 1-year-old girl with a right-sided parietooccipital flattening which was recognized by chance after a head injury. Differential diagnosis: - Unilateral right lambdoid synostosis - Postural right occipital plagiocephaly - Bilateral asymmetric lambdoid suture synostosis. Figure kran_16a_n.jpg: The lateral skull x-ray shows a seemingly rounded back head. In fact, the right-sided flattening is masked by the normal left-sided rounded back head; notice the double-contour more anteriorly caused by the right back head. Figure kran_16b_n.jpg: In the x-ray of the right lambdoid suture a normal structure is visible without a parasutural sclerosis (Towne projection). Figure kran_16c_n.jpg: The CT shows a parietooccipital flattening to the right with a more or less open right lambdoid suture. In addition, a unilateral lambdoid suture does not occur frequently. The final diagnosis is a frequent postural occipital plagiocephaly. A bilateral asymmetric lambdoid synostosis is relatively frequent. But in these cases the head is flattened, too, at the opposite seemingly normal side, and the head is brachycephalic (skull index 90 or more).