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Management of Isolated Sagittal Synostosis in the Absence of Scaphocephaly: A Series of Eight Cases

Morritt, Daniel G. M.R.C.S.; Yeh, Fang-Jui J. M.B.Ch.B.; Wall, Steve A. F.C.S.(S.A.)(Plast.); Richards, Peter G. F.R.C.S.; Jayamohan, Jayaratnam F.R.C.S.; Johnson, David F.R.C.S.(Plast.)

Plastic and Reconstructive Surgery: August 2010 - Volume 126 - Issue 2 - p 572-580
doi: 10.1097/PRS.0b013e3181e09533
PEDIATRIC/CRANIOFACIAL: ORIGINAL ARTICLES

Background: The diagnosis of isolated sagittal synostosis is usually made at birth, with a boat-shaped deformity of the skull (scaphocephaly). The Oxford Craniofacial Unit has successfully managed eight cases of isolated sagittal synostosis without scaphocephaly. To the authors' knowledge, there have been no reports of this in the literature.

Methods: The Oxford Craniofacial Unit database (set up in 2004) was searched. This identified 193 cases of isolated sagittal synostosis, eight of which did not have a scaphocephalic head shape (i.e., a cephalic index <76).

Results: Patients with isolated sagittal synostosis in the absence of scaphocephaly represent 4.1 percent of all isolated sagittal synostosis patients in the authors' database. Intracranial pressure was measured in six of the eight cases and found to be high in four of these (67 percent).

Conclusions: It is unclear why the secondary features of sagittal synostosis did not develop in these cases. Possible explanations include fusion of the suture late after the majority of skull growth has taken place and a patent metopic suture allowing growth to occur anteriorly; other sutures appeared patent radiologically but may not have been functioning normally. Although difficult to recognize, patients with isolated sagittal synostosis in the absence of scaphocephaly are important to identify because they are at high risk of developing raised intracranial pressure. A new management algorithm for treatment of these cases is described that has been used successfully in the Oxford Craniofacial Unit.

Oxford, United Kingdom

From the Oxford Craniofacial Unit, John Radcliffe Hospital.

Received for publication September 15, 2009; accepted February 10, 2010.

Presented at the National Commissioning Group Annual Audit Meeting, in Birmingham, United Kingdom, May of 2009; and the International Society of Craniofacial Surgery XIII Biennial International Conference, in Oxford, United Kingdom, September of 2009.

Disclosures: None of the authors has a financial interest in any of the products or devices mentioned in this article. None of the authors has any commercial associations or conflicts of interest related to this article.

David Johnson, F.R.C.S.(Plast.), Department of Plastic Surgery, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom, davidjohnson@doctors.org.uk

©2010American Society of Plastic Surgeons