Occipital plagiocephaly

Occipital plagiocephaly is a type of plagiocephaly. It is used to describe the shape of the skull which is a result of an early fusion of the lambdoid suture. The premature fusion may occur either on one side or both sides of the suture.

Epidemiology

Clinical presentation

The side which is involved appears flattened when it is viewed from above. Most often a bump is seen behind the ear on the ipsilateral side or the ipsilateral ear might be pulled backwards. However, if the ear is forward on the flat side (with respect to the opposite ear), and there is no reduction in skull height on the affected side, then a skull deformation should be suspected instead of a fused suture. It is critically important to determine whether or not a child truly has a fused suture because skull deformations almost never need to be surgically treated.

Radiographic features

Radiograph

The Towne view is often used for evaluation. However, x-ray might at times give a deceptive appearance of a fused suture.

CT

Ideally, a CT should be performed for the same. Findings typically include:

the absence of suture

flattening over synostosed suture

mastoid overgrowth resulting in bulge behind the involved ear

temporoparietal bossing on opposite side

Treatment and prognosis

Surgical management of lambdoid synostosis involves restructuring the posterior fossa to provide adequate space for normal brain development as well as restoring normal symmetry.